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Intensive Care Medicine

, Volume 33, Issue 3, pp 409–413 | Cite as

Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria

  • Rinaldo Bellomo
  • John A. Kellum
  • Claudio Ronco
Special Article

Abstract

Until recently, more than 30 different definitions of acute renal failure (ARF) had been used in the literature. This lack of a common reference point created confusion and made comparisons difficult. It also led to strong advocacy of a consensus definition. In response to the need for a common definition and classification of ARF, the Acute Dialysis Quality Initiative (ADQI) group of experts developed and published a consensus definition of ARF. This definition goes under the acronym of RIFLE to indicate that it classifies patients with renal dysfunction according to the degree of impairment into patients at risk (R), with injury (I), with failure (F), with sustained loss (L) and with end-stage (E) status in relation to their renal function. This editorial aims to summarize and interpret recent findings concerning the application of the RIFLE criteria to the assessment of the epidemiology and the prediction of the outcome of ARF.

Keywords

Acute renal failure RIFLE definition Epidemiology Outcome Critical illness Cardiac surgery Hemodialysis Hemofiltration Kidney Illness severity 

References

  1. 1.
    Bellomo R, Kellum J, Ronco C (2001) Acute renal failure: time for consensus. Intensive Care Med 27:1685–1688PubMedCrossRefGoogle Scholar
  2. 2.
    Silvester W, Bellomo R, Cole L (2001) Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med 29:1910–1915PubMedCrossRefGoogle Scholar
  3. 3.
    Schaefer JH, Jochimsen F, Keller F, Wegscheider K, Distler A (1991) Outcome prediction of acute renal failure in medical intensive care. Intensive Care Med 17:19–24PubMedCrossRefGoogle Scholar
  4. 4.
    Liano F, Pascual J, and the Madrid Acute Renal Failure Study Cluster (1996) Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Kidney Int 50:811–818PubMedCrossRefGoogle Scholar
  5. 5.
    Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ (1996) Acute renal failure in intensive care units – causes, outcome, and prognostic factors of hospital mortality: a prospective, multicenter study. Crit Care Med 24:192–198PubMedCrossRefGoogle Scholar
  6. 6.
    Cole L, Bellomo R, Silvester W, Reeves JH (2000) A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a “closed” ICU system. Am J Respir Crit Care Med 162:191–196PubMedGoogle Scholar
  7. 7.
    Kellum JA. Mehta RL, Ronco C (2001) Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 132:258–265PubMedCrossRefGoogle Scholar
  8. 8.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, and the ADQI workgroup (2004) 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 8:R204–R210PubMedCrossRefGoogle Scholar
  9. 9.
    Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling CR (2005) Optimal follow-up time after continuous renal replacement therapy in actual renal failure patients stratified with the RIFLE criteria. Nephrol Dial Transplant 20:354–360PubMedCrossRefGoogle Scholar
  10. 10.
    Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM (2005) The outcome of acute renal failure in the intensive care unit according to RIFLE: model applicability, sensitivity, and predictability. Am J Kidney Dis 46:1038–1048PubMedCrossRefGoogle Scholar
  11. 11.
    Kuitunen A, Vento A, Suojaranta-Ylinen R, Pettila V (2006) Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg 81:542–546PubMedCrossRefGoogle Scholar
  12. 12.
    Alström A, Kuitunen A, Peltonen S, Hynninen M, Tallgren M, Aaltonen J, Pettila V (2006) Comparison of 2 acute renal failure severity scored to general scoring systems in the critically ill. Am J Kidney Dis 48:262–268CrossRefGoogle Scholar
  13. 13.
    Laupacis A, sekar N, Stiell IG (1997) Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA 277:488–494PubMedCrossRefGoogle Scholar
  14. 14.
    Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De BAcquer D, Kellum JA (2006) RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 10:R73–R83PubMedCrossRefGoogle Scholar
  15. 15.
    Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C (2006) An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 34:1913–1917PubMedCrossRefGoogle Scholar
  16. 16.
    Lin C-Y, Chen Y-C, Tsai F-C, Tian Y-C, Jeng C-C, Fang J-T, Yang C-W (2006) RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extra-corporeal membrane oxygenation. Nephrol Dial Transplant July 24 [Epub ahead of print]Google Scholar
  17. 17.
    Lopes JA. Jorge S, Neves FC, Caneira M, Da Costa AG, Ferreira AC, Prata MM (2006) An assessment of the rifle criteria for acute renal failure in severely burned patients. Nephrol Dial Transplant July 31 [Epub ahead of print]Google Scholar
  18. 18.
    Lopes JA, Jorge S, Silva S de Almeida E, Abreu F, Martins C, do Camo JA, Lacerda JF, Prata MM (2006) An assessment of the RIFLE criteria following myeloablative autologous and allogenic haematopoietic transplantation. Bone Marrow Transpl 38:395CrossRefGoogle Scholar
  19. 19.
    Bernard G, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American–European Consensus Conference on ARDS. Definitions mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMedGoogle Scholar
  20. 20.
    American College of Chest Physicians/Society of Critical Care Medicine Consensus Committee (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1658–1662Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Rinaldo Bellomo
    • 1
    • 2
  • John A. Kellum
    • 3
  • Claudio Ronco
    • 4
  1. 1.Department of Intensive Care and Department of MedicineAustin Hospital and University of Melbourne, HeidelbergMelbourneAustralia
  2. 2.Department of Intensive CareAustin & Repatriation Medical Centre, HeidelbergVictoria 3084Australia
  3. 3.Department of Critical Care MedicineUniversity of Pittsburgh Medical CentrePittsburghUSA
  4. 4.Department of NephrologyOspedale San BortoloVicenzaItaly

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