An Assessment Of RIFLE And AKIN Criteria For Mortality And Risk Factors Of Acute Kidney Injury In Hospitalized Patients

Background:Acute kidney injury (AKI) is a common emergency in all clinical settings. The morality of AKI remains high at around 65% especially in the intensive care unit. The definition and classification of AKI update constantly. In 2002, the Acute Dialysis Quality Initiative group (ADQI) has published the RIFLE classification criteria for acute renal failure (ARF). In 2005, the Acute Kidney Injury Network (AKIN) group has proposed AKI replace ARF and asserted AKIN classification criteria based on the RIFLE. However, it is rare to estimate mortality and risk factors for acute kidney injury in hospitalized patients according to the RIFLE and AKIN stage.Objective:To estimate mortality and risk factors for acute kidney injury in hospitalized patients according to the RIFLE and AKIN stage.Methods:We constructed a retrospectively study of all AKI patients at the Second Xiangya Hospital of Central South University between February 2006 and January 2011. The diagnosis and classification of AKI were reconfirmed and categorized according to RIFLE and AKIN criteria. To compare the differences between AKI patients according to the RIFLE and AKIN stage respectively in clinical characteristics, mortality and associated risk factors. Univariate analysis and multivariate logistic regression analysis were performed. Results:The patients were diagnosed as AKI by AKIN (1027) or by RIFLE criteria (1020). There was no significant difference among the hospital mortality, hospital length stay (days) and the proportion of complete recovery patients of each stage of AKI between RIFLE and AKIN stage (p>0.05). In univariate analysis, age, pre-renal causes, the proportion of hospital acquired AKI, mechanical ventilation, hypotension, the number of failed organs, ATN-ISS scores and the peak of serum potassium ion concentration were significantly higher in non-survivors than survivors (p<0.05). Logistic regression analysis suggested that age more than 65 years, hospital acquired AKI, hypotension, the number of failed organs, ATN-ISS scores and the peak of serum potassium ion concentration were independent risk factors for hospital mortality. Among the group of patients with AKIâ…¢, there was no significant difference between mortality in patients with blood purification(BP) treatment and nondialytic AKI patients. Timing of initiation of BP was not related to mortality with AKIâ…¢patients. There was no significant difference between the hospital mortality of at different timing of initiating BP treatment(p<0.05). The mortality of the patients who had hemo-dialysis(HD) was lower than that of other patients. There was no significant difference between the mortality in patients who had continuous renal replacement therapy (CRRT) alone and patients with CRRT combination with HD (p>0.05). Conclusion:RIFLE classifisical as well as AKIN stage were found to have the same scientific value in assessing hospital mortality, and AKI stage was associated with recent prognosis of AKI patients.the proportion of complete recovery patients and hospital length stay (days). Compared to the RIFLE criteria, the AKIN criteria were recommended in clinic because it can diagnose AKI earlier. The Age over 65 years, hospital acquired AKI, hypotension, the number of failed organs, ATN-ISS scores and the peak of serum potassium ion concentration were independent risk factors for hospital mortality.