8/10/2019 AKI POSTER

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RIFLE

CLASS

RIFLE GFR Criteria UO Criteria AKIN GFR

CRITERIA

AKIN

CLASS

RISK Increase Cr × 1.5 Or

GFR decreases

>25%

UO < 0.5

ml/kg/hr

× 6 hr

Increase Cr × 

1.5 Or

≥ 0.3 mg/dl 

STAGE 1

INJURY Increase Cr ×  2 Or

GFR decreases

> 50%

UO < 0.5

ml/kg/hr

× 12 hr

Increase Cr × 

2

STAGE 2

FAILURE Increase Cr × 3 Or

GFR decreases

> 75% Or

Cr ≥ 4mg/dl ( with

acute rise of

≥ 0.5 mg/dl) 

UO < 0.3

ml/kg/hr

× 24 hr Or

 Anuria × 12

hr

Increase Cr × 

3 Or

Cr ≥ 4mg/dl (

with acute rise

of ≥ 0.5 mg/dl) 

STAGE 3

LOSS Complete loss of renal function for >

4 weeks

ESRD END STAGE RENAL DISEASES

Table-4 : RIFLE v/s AKIN differences 

ACUTE KIDNEY INJURY IN POST-OP NEUROSURGERY PATIENTS IN

CU: A COMPARISON BETWEEN RIFLE AND AKIN CLASSIFICATION

Dr. Vidit Joshi1 Col(Dr) R Ramprasad2, Brig (Dr)G S Ramesh3 

1Resident Anesthesiology, AFMC Pune.2Associate Professor, Department of Anaesthesiology AFMC Pune

3Professor & HOD, Department of Anaesthesiology AFMC Pune

To study the incidence of AKI in post op

eurosurgery patients in ICU using RIFLE

AKIN criteria

To note whether there are differences in

entification of Acute Kidney injury in post-

p Neurosurgery patients in ICU using

IFLE and AKIN criteria

To study, associated risk factors in the

evelopment of AKI

Objectives 

Acknowledgemen

References

Discussion

Introduction Observation 

Sr No.  Criteria  AKIN  RIFLE 

1  Sr Creatinine

changes 

Change

Within a 48-

hour 

Over a one-week

period from

Baseline 

3  Absolute S.Cr

increment in Stage 1 

Rise of ≥0.3

mg/dL in 48

hrs 

- 

4  Renal replacement

therapy 

Stage 3  No severity class

assigned 

 Acute kidney injury (AKI) is commonly

seen in the perioperative period and in

the intensive care unit (ICU). It is

associated with a prolonged hospital stay,

high morbidity and mortality.1

To date, there is no universally accepted

definition for acute kidney dysfunction.

The criteria for AKI was first published

with acronym RIFLE (Risk, Injury, Failure,

Loss of kidney function, and End-stage

renal failure), to overcome different

definitions for AKI2

More recently, a modified version was

proposed by the Acute Kidney injuryNetwork (AKIN)3 

Neurosurgical patients are more prone to

kidney stress due to blood loss & major

fluid shift, water imbalance in peri-op

period and excessive use of diuretics. 

Materials &

Methods 

Results

Table-3 :RIFLE & AKIN criteria 

Study Design: Prospective observational

study

Study Place: ICU CH(SC), AFMC, Pune

Study Population: All adult Neurosurgical

patients with ICU admission post-op for >

24 hrs

Study Period: DEC 2012 - SEPT 2013

Sample Size: 72 patient

All patients assessed daily for 7 post-op

day using both the RIFLE and AKIN

criteria

MALE43 (60%)

FEMALE29 (40%)

Figure-1: Distribution according to Sex

Non AKI48 (67%)

Stage 119 (26%)

Stage 21 (1%) Stage 3

4 (6%)

Figure-3: Incidence of AKIby AKIN

No AKI57 (79%)

RISK10 (14%)

Injury3 (4%)

Failure2 (3%)

Figure-4: Incidence of AKIby RIFLE criteria

15

23

10

19

54

0

5

10

15

20

25

RIFLE AKIN

Figure-7: PROGRESS OF STAGE 1 / RISK

S TA GE 1 RE COV ER Y H IGH ER GR ADI NG

3

5

0

1 1

0

5

9

4

21

10

2

4

6

8

10

IM DAY 1 DAY2 DAY3 DAY4 DAY5 DAY6 DAY7

Figure-6: Incidence of AKI ON

Post-op Day by AKIN/RIFLE

RIFLE AKIN

1. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. A

kidney injury, mortality, length of stay, and costs in hospitalizedpatients.J Am Soc Nephrol. 2005;16:3365-70.

2. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute

Dialysis Quality Initiative workgroup. Acute renal failure—definitoutcome measures, animal models, fluid therapy and informatio

technology needs:the Second International Consensus Conferen

the Acute Dialysis Quality Initiative (ADQI) .Crit Care. 2004;8:R212.

3. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnoc

et al. Acute Kidney Injury Network: report of an initiative to impr

outcomes in acute kidney injury.Crit Care. 2007;11:R31

No AKI45 (62%)

AKINonly

12 (17%)

AKIN +RIFLE

12 (17%)

RIFLEonly

3 (4%)

Figure-5: Comparison ofAKIN & RIFLE

We are grateful to the Col (Dr) S Singh, Gp Capt.(Dr) R M Sh

Lt Col. (Dr) R Goyal and Department of Anaesthesiology and

critical care, AFMC Pune for their kind guidence and support.

16

911

9

4

3

911

0

5

10

15

20

25

< 30 yrs 31-45 yrs 46-60 yrs > 60 yrs

Figure-2: Distribution according to Age

No AKI AKI

 

Criteria AKI

Mean sd)

Non AKI

Mean sd)

p-

Value

Pre-op Cr (mg/dl)  0.83

(±0.24)

0.96

(±0.20)

0.018 

Pre- Op Urea

(mg/dl) 

29.11

(±10.25)

22.68

(±8.08)

0.795 

Pre- Op K+ (mmol)  4.267

(± 0.38)

4.193

(±0.43)

0.470 

Intra-Op Urine

output (ml) 

1082.59

(±963)

956.89

(±418)

0.446 

Intra-Op Blood loss

(ml) 

653.33

(±256)

529.33

(±190)

0.022 

Duration of Surgery(hr) 

5.74(±1.14)

4.84(±1.84)

0.013 

APACHE score  8.33

(±3.96)

6.04

(±4.95)

0.045 

Criteria

ALL

cases 72)

AKI 27)

Non

AKI 45)

p-Value

Hypertension 16(22.2%) 8(29.6%) 8(17.8%) 0.258

Diabetes 15(20.8%) 10(37.0%) 5(11.1%) 0.015

Liver diseases 2(2.8%) 2(7.4%) 0(0%) 0.047

LVH/ CAD 3(4.2%) 3(11.1%) 0(0%) 0.049

Malignancy 12(16.7%) 4(14.8%) 8(17.8%) 1.000

Seizures 20(27.8%) 8(29.6%) 12(26.7%) 0.792

Immobilization 7(9.7%) 4(14.8%) 3(6.7%) 0.413

Chemotherapy 1(1.4%) 0(0%) 1(2.2%) 1.000

Contrast study 20(27.8%) 13(48.1%) 7(15.6%) 0.006

Transfusion

Reaction

2(2.8%) 1(3.7%) 1(2.2%) 1.000

Hypo

albuminemia

22(30.6%) 12(44.4%) 10(22.2%) 0.045

Conclusion Diagnosis of early AKI was found to

higher using the AKIN than RIFLE criter

Whether there is over-diagnosis by A

than RIFLE criteria cannot be interprete

this study.

 All data analysed using SPSS Version

software

Patient’s age > 60 yr are more prone to

(Figure-2)

More patients were diagnosed as early

by AKIN (33.33%) than by RIFLE (20.8

criteria (P<0.0001). (Figure3-5)

The majority of patients had se

creatinine value increases of greater

50% or greater than 0.3 mg/Dl baseline within the first 48 h

postoperatively (Figure-6)

 Association of Quantitative risk factor s

as Pre-op Sr Creatinine, Intra-op b

loss, Duration of surgery and APACH

score on ICU admission was fo

significant using un-paired test.

 Association of Qualitative risk factor s

as Contrast, Diabetes, Hypo albumine

CAD/LVH and Liver diseases was fo

significant.

Diagnosis of early AKI was higher u

 AKIN than RIFLE criteria.

Outcome prediction (recovery/failure)

comparable in both. (Figure-7)

Increased blood loss, increased opera

time, higher APACHE II score

admission & hypoalbumenemia were fo

to be associated with early AKI.

Limitations : Small sample size , si

center study and no sub group analysis

been done.

TABLE 1: Peri-op risk factors TABLE 2: Risk factors