Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study.

Area of Science:

• Nephrology
• Critical Care Medicine
• Epidemiology

Background:

• Acute renal failure (ARF) is a common complication in critically ill patients.
• Accurate diagnosis and staging of ARF are crucial for patient management and outcomes.
• Existing criteria for ARF diagnosis, such as RIFLE and AKIN, have varying sensitivities and specificities.

Purpose of the Study:

• To determine the incidence of ARF in critically ill patients.
• To compare the performance of the RIFLE and AKIN criteria in diagnosing ARF.
• To evaluate the effectiveness of urinary criteria (UC) versus creatinine criteria (CC) in ARF detection.

Main Methods:

• A prospective, multicenter observational study was conducted over one year in nine polyvalent Critical Care Units (CCUs) in Argentina.
• 627 critically ill patients over 18 years old admitted for >48h were included.
• RIFLE and AKIN criteria were applied using both urinary (UC) and creatinine criteria (CC), with calculated hourly diuresis (CHD) used for UC.

Main Results:

• The incidence of ARF was 69.4% by RIFLE and 51.8% by AKIN.
• UC detected ARF in 59.5% of cases, significantly higher than CC (34.7% RIFLE, 25.3% AKIN).
• ARF incidence and severity correlated with increased mortality (40.9% RIFLE, 44.6% AKIN), but not with length of CCU stay.

Conclusions:

• The RIFLE criteria identified a higher incidence of ARF compared to AKIN.
• Urinary criteria (UC) demonstrated superior effectiveness in detecting ARF compared to creatinine criteria (CC).
• ARF presence and severity are significant predictors of mortality in critically ill patients.