The Outcome of HIV-Positive Patients Admitted to Intensive Care Units with Acute Kidney Injury (original) (raw)
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Prevalence and Outcome of Acute Kidney Injury in the intensive care unit according to RIFLE criteria
Abstract: Acute kidney injury (AKI) is common in the intensive care unit (ICU) and is associated with significant morbidity and mortality. This requires clinicians to be familiar with recent advances in definitions, diagnosis, prevention, and management of AKI in the ICU. The Acute Dialysis Quality Initiative (ADQI) represents the efforts of a workgroup seeking to develop consensus and evidence-based statements in the field of AKI. The ADQI group proposed a consensus graded definition, called the RIFLE criteria (Risk, Injury, Failure, Loss, and End stage). Objective: To estimate the prevalence of AKI in ICU and assess the ability of the RIFLE criteria to predict the outcome of AKI in ICU. Methods: We performed a retrospective cohort study in the internal medicine ICU, Zagazig University Hospital, in the period from January 2010 to December 2010. We excluded patients younger than 15 years, patients receiving chronic hemodialysis admitted to ICU, kidney transplant patients, length of hospital stays were <24 hours, or readmitted to the ICU during the study period. RIFLE criteria classified AKI patients into three stages of increasing severity Risk(R), Injury (I), and Failure (F). The outcomes of AKI patients in ICU were recovery, kidney loss, end stage renal disease (ESRD) or death. Results: The total number of ICU admissions during the study period was 8304 patients. After application of exclusion criteria, the number of the study became 5440 patients. According to RIFLE criteria 1885 (34.65%) had AKI. RIFLE criteria classified them into Risk 13.32%, Injury 11.91% and Failure 9.41%. The crude outcome of AKI patients as follow 77.24% recovered, 9% lost kidney functions and required renal replacement therapy (RRT), and 2.28% reached ESRD. The crude mortality of AKI patients was 20.47% versus 7.76% mortality in patients without AKI. The hospital recovery stratified by RIFLE criteria decreased with worsening RIFLE classes (R, I, F) 84.27%, 79.62% and 64.25% respectively. Patients' lost kidney functions and required RRT stratified by RIFLE criteria increased with worsening RIFLE classes 5.79%, 7.4% and15.62% respectively. Patients reached ESRD stratified by RIFLE criteria increased with worsening RIFLE classes 1.2%, 2% and 4.1% respectively. The hospital mortality AKI patients stratified by RIFLE criteria increased with worsening RIFLE classes 14.48%, 18.36% and 31.64% respectively. The urinary output (UOP) criteria associated with lower mortality and higher recovery rate than creatinine criteria. Conclusion: The prevalence of AKI in the internal medicine ICU, Zagazig University Hospital according to RIFLE criteria is 34.65%. RIFLE criteria are useful in predicting the outcome of AKI patients.
Acute kidney injury (AKI) is common in the intensive care unit (ICU) and is associated with significant morbidity and mortality. This requires clinicians to be familiar with recent advances in definitions, diagnosis, prevention, and management of AKI in the ICU. The Acute Dialysis Quality Initiative (ADQI) represents the efforts of a workgroup seeking to develop consensus and evidence-based statements in the field of AKI. The ADQI group proposed a consensus graded definition, called the RIFLE criteria (Risk, Injury, Failure, Loss, and End stage). Objective: To estimate the prevalence of AKI in ICU and assess the ability of the RIFLE criteria to predict the outcome of AKI in ICU. Methods: We performed a retrospective cohort study in the internal medicine ICU, Zagazig University Hospital, in the period from January 2010 to December 2010. We excluded patients younger than 15 years, patients receiving chronic hemodialysis admitted to ICU, kidney transplant patients, length of hospital stays were <24 hours, or readmitted to the ICU during the study period. RIFLE criteria classified AKI patients into three stages of increasing severity Risk(R), Injury (I), and Failure (F). The outcomes of AKI patients in ICU were recovery, kidney loss, end stage renal disease (ESRD) or death. Results: The total number of ICU admissions during the study period was 8304 patients. After application of exclusion criteria, the number of the study became 5440 patients. According to RIFLE criteria 1885 (34.65%) had AKI. RIFLE criteria classified them into Risk 13.32%, Injury 11.91% and Failure 9.41%. The crude outcome of AKI patients as follow 77.24% recovered, 9% lost kidney functions and required renal replacement therapy (RRT), and 2.28% reached ESRD. The crude mortality of AKI patients was 20.47% versus 7.76% mortality in patients without AKI. The hospital recovery stratified by RIFLE criteria decreased with worsening RIFLE classes (R, I, F) 84.27%, 79.62% and 64.25% respectively. Patients' lost kidney functions and required RRT stratified by RIFLE criteria increased with worsening RIFLE classes 5.79%, 7.4% and15.62% respectively. Patients reached ESRD stratified by RIFLE criteria increased with worsening RIFLE classes 1.2%, 2% and 4.1% respectively. The hospital mortality AKI patients stratified by RIFLE criteria increased with worsening RIFLE classes 14.48%, 18.36% and 31.64% respectively. The urinary output (UOP) criteria associated with lower mortality and higher recovery rate than creatinine criteria. Conclusion: The prevalence of AKI in the internal medicine ICU, Zagazig University Hospital according to RIFLE criteria is 34.65%. RIFLE criteria are useful in predicting the outcome of AKI patients. [Mohamed Fouad and Mabrouk I. Ismail.Prevalence and Outcome of Acute Kidney Injury in the intensive care unit according to RIFLE criteria: A single-center study. Journal of American Science 2011; 7(6):1005-1012].(ISSN: 1545-1003). http://www.americanscience.org.
RIFLE criteria for acute kidney injury in the intensive care units
Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2013
Acute kidney injury (AKI) is commonly occurred in intensive care unit (ICU) patients. The aim of the study was a comparison of RIFLE (Risk of renal injury/Injury to the kidney/Failure of kidney function/Loss of kidney function/End stage disease) classification with other scoring systems in the evaluation of AKI in ICUs. We performed a retrospective study on 409 ICU patients who were admitted during the 5 years period. At the 1(st) day of admission and time of discharge, the total and non-renal Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores were compared to max RIFLE criteria. In this assessment, there was concordance among the results (P < 0.05). The RIFLE classification can be used for detection of AKI in ICU patients.
2014
An audit of acute kidney injury-a prospective study of the epidemiology, management and outcome of patients with acute kidney injury, over a 12 month period at Groote Schuur Hospital, Cape Town, South Africa (a tertiary level teaching hospital). Introduction: Acute kidney injury results from a rapid decline in kidney function. There are many potential causes, some of which are preventable. It carries the risks of mortality, progression to chronic kidney disease and worsening of pre-existing chronic kidney disease. There is a scarcity of data on the epidemiology of acute kidney injury in sub-Saharan Africa. The aims of this study were to describe the epidemiology of acute kidney injury at Groote Schuur hospital, and factors associated with mortality and renal recovery. Methods: This was a prospective observational study of patients with acute kidney injury, referred to Groote Schuur Hospital Renal Unit from the 8 th of July 2012 to the 8 th of July 2013. Ethics approval was granted by the University of Cape Town Human Research Ethics Committee. We excluded patients younger than 13 years, kidney transplant patients, and those not fulfilling the consensus definition of acute kidney injury according to the Kidney Disease: Improving Global Outcomes (KDIGO) group. Data on patient demographics, medical history, clinical observations, investigations, and cause of acute kidney injury was collected from a clerking sheet designed for the study. Patients were followed up at, or after 3 months (90 days) for assessment of survival and renal recovery. The main outcomes were recovery of renal function and mortality at 3 months. Data was entered into an Excel spreadsheet, and imported onto Stata 12.1 for analysis. Results: A total of 366 patients were included. The median age was 44 years (IQR 14-82). Of these 214 were male (58.5%). Referrals were from medical, surgical and obstetrics and gynaecology departments. The majority, 217 (59.3%) were medical referrals. Most, 265 (72.4%) had community acquired acute kidney injury. The majority of the 101 patients with hospital acquired acute kidney injury, 72 (71.3%) had severe, stage 3 acute kidney injury. Hypertension was the commonest co-morbidity, present in 152 (41.5%) of the patients. There were 75 (20.6%) HIV positive patients. Acute tubular necrosis was the most common cause of acute kidney injury, identified in 251 (68.6%) patients. Renal biopsies were carried out in 36 (9.8%) patients. More than half, 202 (55.2%), of the patients were in the intensive care unit, while 204 (55.7%) were dialysed. Fluid input was recorded in 140 patients (38.3%). Overall 3 month mortality was 38.8% (142 patients). Of the 224 surviving patients, 119 (53.1%) had a follow up serum creatinine. Of these, 95 (80.5%) had full renal recovery, and 4 (3.4%) went on to end stage renal disease. On multivariate analysis, mechanical ventilation was strongly associated with mortality at 3 months (OR 2.46, p-value 0.019, 95% CI 1.41-4.03). Sepsis had a borderline significant association with 3 month mortality (OR 1.83, P-value 0.066, 95%CI 1.02-3.27), as did prolonged time to dialysis (OR 1.93, p-value 0.080, 95% CI 0.93-4.03). HIV was not associated with mortality on univariate analysis (OR 1.07, p-value 0.801, 95%CI 0.64-1.80). Conclusions: Acute kidney injury carries a high mortality risk, most significant in mechanically ventilated patients. Sepsis and, in those dialysed, late dialysis, may be associated with a high risk of mortality. Efforts to reduce hospital acquired acute kidney injury and to improve patient fluid balance chart records should be made.
International Criteria for Acute Kidney Injury: Advantages and Remaining Challenges
PLOS Medicine, 2016
• Acute Kidney Injury (AKI) is defined using widely accepted international criteria that are based on changes in serum creatinine concentration and degree of oliguria. • AKI, when defined in this way, has a strong association with poor patient outcomes, including high mortality rates and longer hospital admissions with increased resource utilisation and subsequent chronic kidney disease. • The detection of AKI using current criteria can assist with AKI diagnosis and stratification of individual patient risk. • The diagnosis of AKI requires clinical judgement to integrate the definition of AKI with the clinical situation, to determine underlying cause of AKI, and to take account of factors that may affect performance of current definitions.
Severity and outcome of acute kidney injury according to rifle criteria in the intensive care unit
Introductıon. The aim of this study was to evaluate severity and outcome in patients with acute kidney injury (AKI) in the intensive care unit (ICU) based on the RIFLE criteria. Methods. Adult patients with AKI admitted in medical and surgical ICUs between January 2005 and December 2007 were reviewed retrospectively. The first three criteria of RIFLE were applied. Patients on chronic dialysis before admission to the ICU were excluded. Demographic, biochemical, clinical, APACHE II score and outcome data were studied and compared in the three classes. Results. A total of 76 patients (32F/44M), mean age 55.1+18.75 were examined. 6 % of patients were in the risk class, 19% in the injury and 73 % in the failure class. The failure class showed higher APACHE II score compared to the risk one (24.6+7.6 Vs 28.12+6.4 p= 0.018). The overall in-hospital mortality was 52.6 % with the highest in the failure class (62 %), followed by the injury class (26 %) and the risk class (20 %), with a statis...