Comparison of the usefulness of the RIFLE and acute kidney injury network (AKIN) classifications in intensive care unit patients

Abstract

Objective：The usefulness of the Risk, Injury, Failure, Loss of Kidney Function, End-stage Kidney Disease (RIFLE) and Acute Kidney Injury Network (AKIN) classifications was compared in the patients admitted to the intensive care unit (ICU). Methods：In all, 442 patients who were admitted for more than 48 hours in the ICU of our hospital over the last 3 years were retrospectively evaluated. The grades of difference in the acute physiology and chronic health evaluation (APACHE) Ⅱ score and ICU mortality rate were compared between the 2 classifications. Results：The APACHEⅡscore and ICU mortality rate were not significantly different between the 2 classifications. Only 6 patients were classified as stage 1 according to the AKIN classification, but classified as having no acute kidney injury in RIFLE (an acute change in serum creatinine level：＞0.3mg/dL). A total of 86 patients undergoing renal replacement therapy (RRT) were classified in stage 3 in AKIN, but not classified as Failure in RIFLE. Conclusions：Compared to the RIFLE classification, the AKIN classification does not provide improved ability to predict mortality in ICU patients. There has been no standard to determine when patients need to undergo RRT；therefore, using the RIFLE classification seems more appropriate at this moment for discussing the effective prevention and treatment of AKI.