RIFLE criteria versus Acute Kidney Injury Network (AKIN) criteria for prognosis of acute renal failure

Date First Published:
July 7, 2007
Last Updated:
October 21, 2011
Report by:
Will Bentley, Medical Student (Manchester Royal Infirmary)
Search checked by:
Kerstin Hogg, Manchester Royal Infirmary
Three-Part Question:
In [patients presenting to the emergency department with acute renal failure] is it better to use the [RIFLE or AKIN score] to [predict prognosis]?
Clinical Scenario:
A 70-year-old woman presents to the emergency department (ED) with confusion and collapse. You find her serum creatinine is 180 μmol/l and wonder which classification system you should use to determine her renal function and prognosis.
Search Strategy:
Medline 1996 to July week 1 2011 and Embase 1947 to July 2011 using the OVID interface.
Search Details:
(RIFLE.mp) AND (acute kidney injury network.mp OR AKIN.mp)).
Outcome:
The Medline search identified 36 potentially relevant papers and EMBASE identified 65 papers.
Relevant Paper(s):
Study Title Patient Group Study type (level of evidence) Outcomes Key results Study Weaknesses
A comparative assessment of the RIFLE, AKIN and conventional criteria for acute kidney injury after hematopoietic SCT. Ando M, Mori J, Ohashi K, et al. Japan, 2010 249 Japanese patients who received haemopoietic stem cell transplants Retrospective cohort analysis AUC ROC curve for predicting 100-day mortality in myeloblastic patients RIFLE 0.65. AKIN 0.64 The urine output measures were not used in calculating the scores<br><br>Small sample of select patients
AUC ROC curve for predicting 100-day mortality in non-myeloblastic patients RIFLE 0.77. AKIN 0.73
A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Bagshaw S, George C, Bellomo R; for the ANZICS Database Management Committee. 2008, Australia 120 123 Patients admitted to 57 ICU in Australia or New Zealand 2000–5 Retrospective large database analysis AUC of ROC curve for prediction of inhospital mortality RIFLE 0.66. AKIN 0.67 The urine output measures were not used in calculating the scores
OR for death if any criteria fulfilled in score RIFLE 3.3 (95% CI 3.2 to 3.4) . AKIN 3.1 (95% CI 3.0 to 3.3)
Acute kidney injury classification: comparison of AKIN and RIFLE criteria. Chang C, Lin C, Tian Y, et al. 2010, Japan 291 ICU patients, single centre, 2003–6 Retrospective chart review AUC of ROC curve for prediction of inhospital mortality RIFLE 0.74. AKIN 0.72 Small cohort
Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Englberger L, Suri R, Li Z, et al. 2011, USA 4836 Patients undergoing cardiac surgery Retrospective chart review AUC of ROC curve for 30-day mortality RIFLE 0.80. AKIN 0.82 Retrospective analysis<br><br>The urine output measures were not used in calculating the scores
AUC of ROC curve for intubation >24 h RIFLE 0.66. AKIN 0.67
RIFLE and Acute Kidney Injury Network classifications predict mortality in leptospirosis-associated acute kidney injury. Silva Júnior G, Abreu K, Mota R, et al. 2011, Brazil 287 Patients diagnosed with leptospirosis at two infectious disease hospitals 1985–2008 Retrospective chart review OR for death of patients assigned RIFLE ‘F’ or AKIN ‘3’ RIFLE 11.6 (95% CI 0.5 to 88.0). AKIN 12.8 (95% CI 1.6 to 96.8) Unclear how long patients were followed up for<br><br>Small select patient group
A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery—associated acute kidney injury: a prospective cohort study. Haase M, Bellomo R, Matalanis G, et al. 2009, Italy 282 Patients undergoing cardiac surgery Prospective study AUC of ROC curve for prediction of inhospital mortality RIFLE 0.91. AKIN 0.94 Small population
Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Joannidis M, Metnitz B, Bauer P, et al. 2009, Austria 14 365 Patients from registry of 303 international ICU Retrospective large database analysis OR for inhospital mortality for patients designated RIFLE ‘F’ or AKIN ‘3’ RIFLE 3.0 (95% CI 2.7 to 3.4) .AKIN 3.0 (95% CI 2.6 to 3.4) Limited urine output data
AUC of ROC curve for prediction of inhospital mortality RIFLE 0.84. AKIN 0.84
Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Lopes J, Fernandes P, Jorge S, et al. 2008, Portugal 662 Patients admitted to a single ICU Retrospective review OR for prediction of inhospital mortality for any RIFLE criteria or any AKIN criteria RIFLE 2.8 (95% CI 1.7 to 4.4). AKIN 3.6 (95% CI 2.1 to 6.0) Retrospective study<br><br>The urine output measures were not used in calculating the scores
AUC of ROC curve for prediction of inhospital mortality RIFLE 0.73. AKIN 0.75
Challenges of defining acute kidney injury. Ostermann M, Chang R. 2011, UK 41 792 ICU patients from 22 ICU units in UK and Germany, 1989–99 Retrospective large database review AUC of ROC curve for prediction of inhospital mortality RIFLE 0.90. AKIN 0.84 The urine output measures were not used in calculating the scores
Cardiac surgery-associated acute kidney injury: a comparison of two consensus criteria. Robert A, Kramer R, Dacey L, et al. 2010, USA 24 747 Patients undergoing cardiac surgery in northern New England 2001–7 Large database review OR for inhospital mortality RIFLE ‘R’ 2.4 (95% CI 2.0 to 2.9)<br><br>RIFLE ‘I’ 8.9 (95% CI 7.3 to 11.0)<br><br>RIFLE ‘F’ 10.9 (95% CI 33.9 to 49.3)<br><br>AKIN ‘1’ 3.1 (95% CI 2.6 to 3.8)<br><br>AKIN ‘2’ 12.4 (95% CI 9.8 to 15.7)<br><br>AKIN ‘3’ 43.8 (95% CI 36.2 to 52.9) The urine output measures were not used in calculating the scores
AUC of ROC curve for prediction of inhospital mortality p Value for equity of ROC areas 0.369 (no difference in areas)
Acute kidney injury in adult postcardiotomy patients with extracorporeal membrane oxygenation: evaluation of the RIFLE classification and the Acute Kidney Injury Network criteria. Yan X, Jia S, Meng X, et al. 2009, China 67 Patients at a single centre who received extracorporeal membrane oxygen support after cardiac surgery 2004–8 Retrospective chart review OR for inhospital mortality RIFLE ‘R’ 2.1 (95% CI 0.3 to 15.4)<br><br>RIFLE ‘I’ 8.6 (95% CI 1.4 to 51.2)<br><br>RIFLE ‘F’ 12.6 (95% CI 2.2 to 72.3)<br><br>AKIN ‘1’ 2.7 (95% CI 0.3 to 30.8)<br><br>AKIN ‘2’ 5.1 (95% CI 0.5 to 56.9)<br><br>AKIN ‘3’ 30.8 (95% CI 3.3 to 287.2) Select, small population
AUC of ROC curve for prediction of inhospital mortality RIFLE 0.74. AKIN 0.80
Author Commentary:
No study has assessed the utility of either score in the ED. Most studies did not apply the urine output criteria, which would be more relevant to the ED population.
Bottom Line:
Both the RIFLE and AKIN score are predictive of inpatient mortality, and appear to be equally as good.
References:
  1. Ando M, Mori J, Ohashi K, et al. . A comparative assessment of the RIFLE, AKIN and conventional criteria for acute kidney injury after hematopoietic SCT.
  2. Bagshaw S, George C, Bellomo R; for the ANZICS Database Management Committee.. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients.
  3. Chang C, Lin C, Tian Y, et al. . Acute kidney injury classification: comparison of AKIN and RIFLE criteria.
  4. Englberger L, Suri R, Li Z, et al. . Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery.
  5. Silva Júnior G, Abreu K, Mota R, et al. . RIFLE and Acute Kidney Injury Network classifications predict mortality in leptospirosis-associated acute kidney injury.
  6. Haase M, Bellomo R, Matalanis G, et al. . A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery—associated acute kidney injury: a prospective cohort study.
  7. Joannidis M, Metnitz B, Bauer P, et al.. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database.
  8. Lopes J, Fernandes P, Jorge S, et al. . Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications.
  9. Ostermann M, Chang R. . Challenges of defining acute kidney injury.
  10. Robert A, Kramer R, Dacey L, et al. . Cardiac surgery-associated acute kidney injury: a comparison of two consensus criteria.
  11. Yan X, Jia S, Meng X, et al. . Acute kidney injury in adult postcardiotomy patients with extracorporeal membrane oxygenation: evaluation of the RIFLE classification and the Acute Kidney Injury Network criteria.