An assessment of the RIFLE criteria for acute renal failure in critically ill HIV-infected patients
Critical Care volume 11, Article number: 401 (2007)
Acute renal failure is common among hospitalized patients with HIV infection, particularly in the intensive care unit (ICU) setting, and increases mortality. Recently, the Acute Dialysis and Quality Initiative (ADQI) group  formulated a new classification for acute renal failure – the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification – that defines three grades of severity – class R (risk), class F (failure), and class I (injury) – and two outcome classes – loss and end-stage kidney disease. Some studies [2, 3] have applied the RIFLE criteria in hospitalized patients, particularly in ICU patients, but the clinical ability of these criteria to predict outcome of ICU HIV-infected patients has not yet been assessed. We sought to evaluate retrospectively the ability of the RIFLE criteria (Table 1) to predict outcome of the HIV-infected patients admitted to the Infectious Diseases ICU of our Hospital (Hospital de Santa Maria, Lisbon, Portugal) between January 2002 and June 2006. Chronic kidney disease patients receiving dialysis were excluded from the analysis. Mortality was assessed at day 60 . We evaluated 97 HIV-infected patients (mean age 42.7 ± 12.2 years; 77 male, 69 Caucasian). According to RIFLE, 46 patients (47.4%; mean age 43.2 ± 11.08 years, P = not significant; 39 male, P = not significant; 28 Caucasian, P = not significant) had some degree of acute renal dysfunction. Of these, 12 patients (26%) were class R, 9 patients (19.5%) were class I, and 25 patients (54.3%) were class F; these patients did not differ in terms of age, gender, race, type of HIV, stage of HIV infection, highly active antiretroviral therapy (HAART), comorbidity, and severity of illness. In all cases, maximum RIFLE occurred within the first week of hospitalization.
Overall mortality was 43.3% and increased significantly from normal to class F (normal, 23.5%; class R, 50%; class I, 66.6%; and class F, 72%; P < 0.0001). The majority of patients (95%) died in the ICU within the first month of hospitalization. Multivariate regression analysis, including age, gender, comorbidity, RIFLE class and simplified acute physiology score (SAPS) II showed that only class I (odds ratio 5.12, 95% confidence interval 1.07 to 24.28, P = 0.04) and class F (odds ratio 4.6, 95% confidence interval 1.57 to 13.5, P = 0.005), as well as SAPS II (odds ratio 1.04, 95% confidence interval 1.01 to 1.07, P = 0.005) emerged as independent predictors of mortality. As SAPS II (area under receiver operating characteristic 0.699 ± 0.055; P = 0.001), the RIFLE classification had good discriminative power (area under receiver operating characteristic 0.732 ± 0.053; P < 0.0001). In sum, acute kidney injury, defined by means of the RIFLE criteria, is common among critically ill HIV-infected patients, and RIFLE seems a helpful tool in the prognostic stratification of ICU HIV-infected patients.
HAART = highly active antiretroviral therapy
ICU = intensive care unit
- RIFLE = Risk:
Injury, Failure, Loss, and End-stage kidney disease
SAPS = simplified acute physiology score.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, and 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 2004, 8: R204-R212. 10.1186/cc2872
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006, 10: R73. 10.1186/cc4915
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: 1913-1917. 10.1097/01.CCM.0000224227.70642.4F
The authors declare that they have no competing interests.
JAL, JF, SJ made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data. JAL, JN, FA, and MMP were involved in drafting the manuscript and revising it critically for important intellectual content. All authors have given final approval of the version to be published.
Authors’ original submitted files for images
Below are the links to the authors’ original submitted files for images.
About this article
Cite this article
Lopes, J.A., Fernandes, J., Jorge, S. et al. An assessment of the RIFLE criteria for acute renal failure in critically ill HIV-infected patients. Crit Care 11, 401 (2007). https://doi.org/10.1186/cc5121
- Intensive Care Unit
- Chronic Kidney Disease
- Acute Renal Failure
- Acute Kidney Injury
- Intensive Care Unit Patient