Yoğun bakım hastalarında RIFLE sınıflandırmasına göre akut böbrek yetmezliği gelişme insidansı: Retrospektif çalışma
Öz
Amaç: Çalışmamızda RIFLE kriterlerini kullanılarak, yoğun bakım hastalarında akut böbrek hasarı gelişme insidansı, risk faktörleri ve mortalite ile olan ilişkisini değerlendirmeyi hedefledik.
Gereç ve Yöntem: Hastanemiz etik kurul onay belgesi alındıktan sonra (10-9/3, 27.09.2010) anestezi yoğun bakım ünitesine bir yıl içinde başvuran hastaların dosyaları retrospektif olarak incelendi. Hastalar serum kreatinin değeri, idrar çıkışı ve glomerüler filtrasyon hızına göre; RIFLE dışı, R (risk), I (ınjury), F (failure), L (loss of kidney function) ve E (end stage kidney disease) olarak gruplara ayrıldı. Demografik veriler, primer tanı, vazopressör ve diüretik ilaç kullanımı, renal replasman tedavisi, APACHE II skoru, yoğun bakım yatış süresi ve sonuç bilgileri hasta dosyalarından kaydedildi.
Bulgular: Çalışma süresince 522 hasta yoğun bakım ünitesine kabul edildi, 214’ü çalışmaya dahil edildi. Hastaların %79,9’ unda akut böbrek hasarı görülmüş olup maksimum RIFLE kriterlerine göre dağılımları; R %26,6, I %14,9, F %37,9, L %0,5 şeklindeydi. Hiçbir hastada son dönem böbrek yetmezliği (E) gelişmezken, %20,1 hasta RIFLE sınıf dışı olarak bulundu. Çalışmamızda RIFLE sınıflamasına göre mortalite oranları; Risk grubunda %16,1, injury grubunda %17,0 ve failure grubunda %63,4 iken RIFLE sınıflaması dışında kalan grupta %3,6 olarak bulundu (p<0,001).
Sonuç: RIFLE sınıflaması ile yoğun bakımdaki mortalite oranları arasında anlamlı bir ilişki olduğu, RIFLE şiddet derecesi arttıkça mortalite oranının arttığı gösterilmiştir.
Anahtar Kelimeler
Kaynakça
- Bellomo R, Kellum JA, Ronco C. Defining acute renal failure: physiological principles. Intensive Care Med. 2004;30:33-7.
- Bellomo R, Kellum C, Mehta R, Palevsky P, the ADQI Workgroup. Acute renal failure — definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care Forum. 2004;8: R204-12.
- Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM. The outcome of acute renal failure in the intensive care unit according to RIFLE: Model application, sensitivity, and predictability. Am J Kidney Dis. 2005;46:1038-48.
- Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006;34:1913-7.
- Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004;66:1613-21.
- Cruz DN, Bolgan I, Perazella MA, Bonello M, de Cal M, Corradi V, Polanco N, Ocampo C, Nalesso F, Piccinni P, Ronco C; North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI) Investigators. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE Criteria. Clin J Am Soc Nephrol 2007 May;2(3):418-25.
- Hoste EJA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care. 2006;10:R7.
- Uchino S, Kellum JA, Bellomo B, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients. JAMA. 2005;294:813-8.
- Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling C-R. Nephrol Dial Transplant. 2005;20:354-60.
- Ostermann M, Chang RWS. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007 Aug;35(8):1837-43.
- Kuitunen A, Vento A, Suojaranta-Ylinen R, et al. Acute renal failure after cardiac surgery: Evaluation of the RIFLE classification. Ann Thorac Surg. 2006;81:542-6.
- Abosaif NY, Tolba YA, Heap M, et al. The outcome of acute renal failure in the intensive care unit according to RIFLE: Model application, sensitivity, and predictability. Am J Kidney Dis. 2005;46:1038-48.
- Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004;66:1613-21.
- Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 2008;73:538.
- Mehta RL, Pascual MT, Gruta CG, Zhuang S, Chertow GM. Refining predictive models in critically ill patients with acute renal failure. J Am Soc Nephrol. 2002;13:1350-7.
- Kellum JA, Decker JM. Use of dopamine in acute renal failure: A meta-analysis. Crit Care Med. 2001;29:1526-31.
- Mehta RL, Letteri JM. Current status of renal replacement therapy for acute renal failure. A survey of US nephrologists. Am J Nephrol. 1999;19:377-82.
- Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus JM. Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med. 1995;155:1505-11.
- Gomes E, Antunes R, Dias C, Araújo R, Costa-Pereira A. Acute kidney injury in severe trauma assessed by RIFLE criteria: a common feature without implications on mortality? Scand J Trauma Resusc Emerg Med. 2010;18:1.
- Mehta RL, Kellum JA, Shah SV, et al., for the Acute Kidney Injury Network. Report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.
- Lopes JA, Jorge S, Neves FC, Caneira M, da Costa AG, Ferreira AC, Prata MM. An assessment of the RIFLE criteria for acute renal failure in severely burned patients. Nephrol Dial Transplant. 2007;22:285.
- Lin CY, Chen YC, Tsai FC, et al. RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. Nephrol Dial Transplant 2006;21:2867-287.
- Lamiere N, Vanholder R. Pathophysiologic features and prevention of human and experimental acute tubular necrosis. J Am Soc Nephrol 2001;12:20-32.
- Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005 Nov;16(11):3365-70.
- O'Brien MM, Gonzales R, Shroyer AL, Grunwald GK, Daley J, Henderson WG, Khuri SF, Anderson RJ. Modest serum creatinine elevation affects adverse outcome after general surgery. Kidney Int 2002 Aug;62(2):585-92.
- Coca SG, Peixoto AJ, Garg AX, Krumholz HM, Parikh CR. The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. Am J Kidney Dis 2007 Nov;50(5):712-20.
- Hoste EA, Kellum JA. Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care 2006 Dec;12(6):531-7.
Incidence of acute kidney ınjury in ıntensive care unit patients according to RIFLE classification: A retrospective study
Öz
Aim: The aim of this study is to assess the incidence of acute kidney injury, evaluate its risk factors, and investigate the association with mortality among patients in intensive care units, utilizing the RIFLE criteria.
Materials and Methods: The study protocol received approval from the ethics committee at Ege University (10-9/3, 27.09.2010). Records of all patients admitted to the intensive care unit over the course of one year were reviewed retrospectively. Patients were categorized into groups based on the RIFLE classification: non-RIFLE, risk (R), injury (I), failure (F), loss of kidney function (L), and end-stage kidney disease (E).
This classification was determined by serum creatinine levels, urine output, and glomerular filtration rate values. Variables such as demographic data, primary diagnoses, vasopressor use, diuretics use, renal replacement therapy, APACHE II score, length of stay in intensive care unit and outcome were collected from patient medical charts.
Results: Out of 522 patients admitted to the intensive care unit, only 214 were subsequently included in the study. Acute kidney injury was found in 79.9% of patients, with the RIFLE categories as follows: 20.1% non-RIFLE, 26.6% in R, 14.9% in I, 37.9% in F and 0.5% in L. None progressed to end-stage kidney disease. Mortality rates varied: 3.6% for non-RIFLE, 16.1% for R, 17.0% for I and 63.4% for F group (p < 0.001).
Conclusion: There is a strong correlation between the RIFLE classification and mortality rates in the intensive care unit. As the severity of the RIFLE class increases, the mortality rate correspondingly increases.
Anahtar Kelimeler
Acute kidney injury intensive care units RIFLE classification
Kaynakça
- Bellomo R, Kellum JA, Ronco C. Defining acute renal failure: physiological principles. Intensive Care Med. 2004;30:33-7.
- Bellomo R, Kellum C, Mehta R, Palevsky P, the ADQI Workgroup. Acute renal failure — definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care Forum. 2004;8: R204-12.
- Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM. The outcome of acute renal failure in the intensive care unit according to RIFLE: Model application, sensitivity, and predictability. Am J Kidney Dis. 2005;46:1038-48.
- Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006;34:1913-7.
- Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004;66:1613-21.
- Cruz DN, Bolgan I, Perazella MA, Bonello M, de Cal M, Corradi V, Polanco N, Ocampo C, Nalesso F, Piccinni P, Ronco C; North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI) Investigators. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE Criteria. Clin J Am Soc Nephrol 2007 May;2(3):418-25.
- Hoste EJA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care. 2006;10:R7.
- Uchino S, Kellum JA, Bellomo B, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients. JAMA. 2005;294:813-8.
- Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling C-R. Nephrol Dial Transplant. 2005;20:354-60.
- Ostermann M, Chang RWS. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007 Aug;35(8):1837-43.
- Kuitunen A, Vento A, Suojaranta-Ylinen R, et al. Acute renal failure after cardiac surgery: Evaluation of the RIFLE classification. Ann Thorac Surg. 2006;81:542-6.
- Abosaif NY, Tolba YA, Heap M, et al. The outcome of acute renal failure in the intensive care unit according to RIFLE: Model application, sensitivity, and predictability. Am J Kidney Dis. 2005;46:1038-48.
- Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004;66:1613-21.
- Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 2008;73:538.
- Mehta RL, Pascual MT, Gruta CG, Zhuang S, Chertow GM. Refining predictive models in critically ill patients with acute renal failure. J Am Soc Nephrol. 2002;13:1350-7.
- Kellum JA, Decker JM. Use of dopamine in acute renal failure: A meta-analysis. Crit Care Med. 2001;29:1526-31.
- Mehta RL, Letteri JM. Current status of renal replacement therapy for acute renal failure. A survey of US nephrologists. Am J Nephrol. 1999;19:377-82.
- Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus JM. Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med. 1995;155:1505-11.
- Gomes E, Antunes R, Dias C, Araújo R, Costa-Pereira A. Acute kidney injury in severe trauma assessed by RIFLE criteria: a common feature without implications on mortality? Scand J Trauma Resusc Emerg Med. 2010;18:1.
- Mehta RL, Kellum JA, Shah SV, et al., for the Acute Kidney Injury Network. Report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.
- Lopes JA, Jorge S, Neves FC, Caneira M, da Costa AG, Ferreira AC, Prata MM. An assessment of the RIFLE criteria for acute renal failure in severely burned patients. Nephrol Dial Transplant. 2007;22:285.
- Lin CY, Chen YC, Tsai FC, et al. RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. Nephrol Dial Transplant 2006;21:2867-287.
- Lamiere N, Vanholder R. Pathophysiologic features and prevention of human and experimental acute tubular necrosis. J Am Soc Nephrol 2001;12:20-32.
- Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005 Nov;16(11):3365-70.
- O'Brien MM, Gonzales R, Shroyer AL, Grunwald GK, Daley J, Henderson WG, Khuri SF, Anderson RJ. Modest serum creatinine elevation affects adverse outcome after general surgery. Kidney Int 2002 Aug;62(2):585-92.
- Coca SG, Peixoto AJ, Garg AX, Krumholz HM, Parikh CR. The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. Am J Kidney Dis 2007 Nov;50(5):712-20.
- Hoste EA, Kellum JA. Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care 2006 Dec;12(6):531-7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Anesteziyoloji, Yoğun Bakım |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 8 Eylül 2025 |
| Gönderilme Tarihi | 18 Mart 2025 |
| Kabul Tarihi | 5 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 64 Sayı: 3 |
