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Acute renal failure after cardiac surgery: evaluation of the RIFLE classification

Anne Kuitunen1, Antti Vento, Raili Suojaranta-Ylinen

  • 1Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. anne.kuitunen@hus.fi

The Annals of Thoracic Surgery
|January 24, 2006
PubMed

Insights

The Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE) classification effectively identifies acute kidney injury after cardiac surgery. Higher RIFLE severity correlates with increased 90-day mortality risk in these patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Critical Care Medicine

Background:

  • Acute kidney injury (AKI) is a significant risk factor for mortality following cardiac surgery.
  • Standardized definitions for AKI are lacking, complicating accurate assessment and risk stratification.
  • The Acute Dialysis Quality Initiative Workgroup proposed consensus criteria for AKI definition.

Purpose of the Study:

  • To evaluate the RIFLE classification for determining postoperative renal impairment in cardiac surgical patients.
  • To assess the association between RIFLE-defined renal impairment severity and 90-day mortality after cardiac surgery.

Main Methods:

  • Analysis of 813 consecutive patients undergoing cardiac surgery.
  • Classification of patients into RIFLE categories (Risk, Injury, Failure) based on plasma creatinine levels or urine output.
  • Determination of the discriminative ability of RIFLE for 90-day mortality.

Main Results:

  • 19.3% of patients exhibited renal impairment post-cardiac surgery according to RIFLE criteria.
  • Patients in RIFLE-F (Failure) had a 32.5% 90-day mortality rate, versus 8.0% for RIFLE-R (Risk) and 21.4% for RIFLE-I (Injury).
  • RIFLE classification demonstrated strong discrimination for 90-day mortality (AUC 0.824) and was an independent risk factor (p < 0.0001).

Conclusions:

  • The RIFLE classification is a valuable tool for assessing acute kidney injury after cardiac surgery.
  • The severity of RIFLE classification is significantly associated with an increased 90-day mortality rate.
Abstract

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