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Updated: Jul 10, 2026
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
RIFLE criteria for acute kidney injury in aortic arch surgery
George J Arnaoutakis1, Azra Bihorac, Tomas D Martin
1Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla, USA.
Objective:
The RIFLE criteria are new international consensus definitions for acute kidney injury introduced to facilitate research across disciplines. We identified risk factors for acute kidney injury, renal replacement therapy, and mortality using the RIFLE criteria (RIFLE = risk, injury, failure, loss, end stage) in patients undergoing deep hypothermic circulatory arrest for aortic arch reconstruction.
Methods:
A single-center retrospective cohort study of 267 patients undergoing aortic arch surgery with deep hypothermic circulatory arrest was conducted between July 2001 and October 2005. Known predictors (age, chronic kidney disease, surgery status, redo, diabetes, hypertension, blood transfusion, bypass, and deep hypothermic circulatory arrest time) were used in multivariate logistic regression models for acute kidney injury, renal replacement therapy, and mortality.
Results:
Mean age was 64 years (range 23-89 years) with 166 men (62%). Seventy-five (28%) had RIFLE scores of I or F, and 22 (8%) required dialysis. Risk factors for acute kidney injury were hypertension (odds ratio [OR] = 2.17; 95% confidence intervals [CI], 1.14-4.15), chronic kidney disease (OR = 9.04; 95% CI, 1.97-41.59), packed red blood cells greater than 5 units (OR = 2.37; 95% CI, 1.20-4.69), and admission creatinine/Modification of Diet in Renal Disease predicted creatinine ratio greater than 1 (OR = 3.54; 95% CI, 1.95-6.45). Risk factors for mortality were age (per 10 years) (OR = 2.35; 95% CI, 1.35-4.06), AKI (RIFLE class R, I, or F) (OR = 4.60; 95% CI, 1.34-15.77), and cerebrovascular accident (OR = 19.1; 95% CI, 4.96-73.58). Mortality increased with each RIFLE stratification (RIFLE class 0 = 3%, R = 9%, I = 12%, and F = 38%).
Conclusions:
Acute kidney injury as defined according to the RIFLE classification is a risk factor for mortality and will be useful in future studies of renal dysfunction in thoracic aortic surgery.
Insights
Acute kidney injury (AKI) identified by RIFLE criteria is a significant risk factor for mortality in patients undergoing aortic arch surgery. Early identification and management of AKI are crucial for improving patient outcomes.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) poses a significant challenge in patients undergoing major cardiovascular procedures.
- The RIFLE (Risk, Injury, Failure, Loss, End-stage) criteria provide a standardized definition for AKI, facilitating research and clinical assessment.
- Deep hypothermic circulatory arrest (DHCA) during aortic arch reconstruction is associated with a high risk of renal dysfunction.
Purpose of the Study:
- To identify risk factors for AKI, renal replacement therapy (RRT), and mortality in patients undergoing aortic arch reconstruction with DHCA.
- To evaluate the utility of the RIFLE criteria in stratifying AKI severity and predicting outcomes in this patient population.
Main Methods:
- A retrospective cohort study included 267 patients who underwent aortic arch surgery with DHCA between 2001 and 2005.
- Multivariate logistic regression models were employed to analyze predictors of AKI, RRT, and mortality.
- Known risk factors including age, comorbidities, and surgical variables were assessed.
Main Results:
- 28% of patients developed AKI (RIFLE class I or F), and 8% required dialysis.
- Hypertension, chronic kidney disease, blood transfusion volume, and elevated admission creatinine ratio were significant risk factors for AKI.
- Age, AKI (RIFLE class R, I, or F), and cerebrovascular accident were independent risk factors for mortality.
- Mortality rates increased progressively with each RIFLE severity class (3% in class 0 to 38% in class F).
Conclusions:
- AKI, as defined by RIFLE criteria, is a significant independent risk factor for mortality following thoracic aortic surgery.
- The RIFLE classification is valuable for assessing renal dysfunction severity and predicting outcomes in patients undergoing aortic arch reconstruction.
- Further research into renal dysfunction in this surgical context is warranted.
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