Intensive Care Medicine

, Volume 33, Issue 4, pp 597–605 | Cite as

RIFLE classification in patients with acute kidney injury in need of renal replacement therapy

  • Elizabeth MaccarielloEmail author
  • Márcio Soares
  • Carla Valente
  • Lina Nogueira
  • Ricardo V. R. Valença
  • José E. S. Machado
  • Eduardo Rocha



To evaluate the association of RIFLE classification with the outcomes of critically ill patients with acute kidney injury (AKI) who require renal replacement therapy (RRT).

Design and setting

Prospective cohort study in the medical-surgical ICUs at three tertiary hospitals.


214 patients over 1 year (mean age 71.4 ± 15.8 years). Continuous RRT was used in 179 (84%); patients were classified as risk (25%), injury (27%), or failure (48%). Overall mortality was 76%.

Measurements and results

There were no significant differences according to RIFLE classification (risk 72%, injury 79%, failure 76%). Variables selected in multivariate analysis were: older age (OR 1.03, 95% CI 1.01–1.06), presence of comorbidity (3.15, 1.10–9.02), poor chronic health status (6.51, 1.95–21.71), number of associated organ dysfunctions (patients with one or two organ dysfunctions 5.93, 2.03–17.33; patients with three or more organ dysfunctions 26.76, 6.28–114.11), and start of RRT after the first day of ICU (2.46, 1.09–5.53). RIFLE classification was forced into the model and was not selected. However, a subgroup analysis of 150 patients who received mechanical ventilation and vasopressors found failure to be associated with increased mortality (3.58, 1.08–11.80).


Older age, number of organ dysfunctions, presence of comorbidities, and reduced functional capacity were the main prognostic factors. Patients who required RRT after the first day of ICU had a worse outcome. The RIFLE classification did not discriminate the prognosis in patients with AKI in need for RRT.


Acute renal failure RIFLE classification Prognosis Intensive care unit Renal replacement therapy Dialysis 



This work was performed at the intensive care units of Rede D'Or de Hospitais, Rio de Janeiro, Brazil.


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Elizabeth Maccariello
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  • Márcio Soares
    • 4
    • 6
  • Carla Valente
    • 4
    • 5
  • Lina Nogueira
    • 4
  • Ricardo V. R. Valença
    • 4
    • 5
  • José E. S. Machado
    • 4
    • 5
  • Eduardo Rocha
    • 2
    • 4
    • 5
    • 7
  1. 1.Rio de JaneiroBrazil
  2. 2.Laboratório Multidisciplinar de Pesquisa do Hospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
  3. 3.Department of Nephrology, Hospital Universitário Antônio PedroUniversidade Federal FluminenseRio de JaneiroBrazil
  4. 4.NepHro ConsultoriaRio de JaneiroBrazil
  5. 5.Rede D’Or de HospitaisRio de JaneiroBrazil
  6. 6.Intensive Care UnitInstituto Nacional de CâncerRio de JaneiroBrazil
  7. 7.Department of Nephrology, Faculdade de MedicinaUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil

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