Implementation of RIFLE criteria and assessment of factors that affect the prognosis in patients with acute renal failure in intensive care

Year 2013, Volume: 40 Issue: 4, 555 - 561, 01.12.2013

Celil Alper Usluoğulları Sedat Caner Fevzi Balkan Vedat Kılıç Siren Sezer

https://doi.org/10.5798/diclemedj.0921.2013.04.0332

Abstract

Objective: Acute renal failure (ARF) was seen in 5-20% of patients in intensive care unit (ICU). The disturbances of metabolic and hormonal functions contribute to increase the rate of mortality and morbidity in the patients whose have ARF. In our study, firstly we separated the patients, have ARF, into the groups as RIFLE classification after that we compared the collected data from clinic and laboratory, at the same time we evaluated the factors may effects the prognosis of patients. Methods: The fifty patients that have ARF in the intensive care unit of Başkent Universty Hospital were included. The patients divided into three groups, which are called risk, injury and failure according to RIFLE classification. The grouped patients are compared as laboratory and clinical features. We planned that divide the patients into two groups as died and alive according to prospective follow up, when we put diagnosis, we record the vital signs and laboratory values. Results: There is a considerable difference as statistical between RIFLE groups about insulin resistance (HOMA-IR). (p =0,034, p =0,004). When we compare the patient whether they needs hemodialysis or not, during the patient being at intensive care unit, and mortality rate, we saw considerable difference as statistical (p =0,017, p =0,010, p =0,001). Glucose, insulin level, and HOMA-IR observed meaningful as statistical in the exitus groups. (p =0,040, p=0.048, p =0,001). Conclusion: We think that the close monitoring of blood glucose and the controlled insulin treatment may be beneficial by taking into consideration of high mortality rate in the patient with ARF accompanying hyperglycemia and insulin resistance.

Keywords

ARF, RIFLE classification, hyperglycemia, prognosis

Akut böbrek yetmezliği gelişen yoğun bakım hastalarında Rifle kriterlerinin uygulanması ve prognoza etki eden faktörlerin değerlendirilmesi

Abstract

Amaç: Akut böbrek yetmezliği (ABY), yoğun bakım ünitelerinde yatmakta olan hastalarda %5-20 oranında görülmektedir. Metabolik ve hormonal fonksiyonlardaki bozulmalar ABY gelişen hastalarda mortalite ve morbiditenin artmasına da katkıda bulunabilirler. Çalışmamızda yoğun bakım ünitesinde ABY gelişen hastaları önce RIFLE sınıflamasına göre gruplara ayırıp klinik ve laboratuvar değerlerini karşılaştırdık, bunun yanında hastaların prognozuna etkili olabilecek faktörleri değerlendirdik. Yöntemler: Çalışmaya, Başkent Üniversitesi Tıp Fakültesi Hastanesi yoğun bakım ünitesinde ABY gelişen toplam 50 hasta dahil edildi. RIFLE sınıflamasına göre hastalar risk, injury ve failure olmak üzere 3 gruba ayrıldı. Hasta grupları klinik ve laboratuvar özellikleri ile karşılaştırıldı. Prospektif takiplerine göre hastalar eksitus ve sağ kalan olarak iki gruba ayrıldı, her iki grubun ABY tanısı aldığındaki vital bulguları ve laboratuvar değerleri kaydedildi. Bulgular: İnsülin direnci (HOMA-IR), RIFLE grupları arasında istatiksel olarak anlamlı farklılık gösteriyordu (p=0,034,p=0,004). Hastaların hemodiyaliz ihtiyacı olup olmaması, yoğun bakımda yatış süreleri ve mortalite oranları gruplar arasında karşılaştırıldığında istatiksel olarak anlamlı farklar saptandı (p =0,017, p =0,010, p=0,001). Glukoz, insülin düzeyleri ve HOMA-IR eksitus olan grupta istatiksel olarak anlamlı farklı bulundu (p=0,040, p=0.048, p =0,001). Sonuç: Hiperglisemi ve insülin direncinin de eşlik ettiği ABY hastalarındaki yüksek mortalite oranları göz önüne alınarak, bu hastalarda yakın kan glukoz düzeyi takibi, ılımlı ve kontrollü insülin tedavisinin de yararlı olabileceğini düşünmekteyiz.

Keywords

ABY, RIFLE sınıflaması, hiperglisemi, prognoz

References

• Palevsky PM, Liu KD, Brophy PD, et al. KDOQI US com- mentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis 2013;61:649-672.
• Carmichael P, Carmichael AR. Acute renal failure in surgical setting. ANZ J Surg 2003;73: 144-153.
• Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units: causes, outcome, prognos- tic factors of hospital mortality: a prospective, multicenter study. Crit Care Med 1996;26:915-921.
• Mehta RL. Acute renal failure in the intensive care unit: which outcomes should we measure? Am J Kidney Dis 1996;28:816-821.
• Wim VB, Raymoond V. Defining acute renal failure: RIFLE. Clin J Am Soc Nephrol 2006;1314-1319.
• Bates CM, Lin F. Future strategies in the treatment of acute renal failure: growth factors, Stem cells, and the novel ther- apies. Lippincott Williams &Wilkins 2005;1040-8703.
• Seema B, Lara BP, Edith M. Insulin resistance in critically il lpatients with acute renal failure: Am J Physiol Renal Physiol 2005;289:259–264.
• Preiser JC, Devos P, Van den Berghe G. Tight control of gly- caemia in critically ill patients. Curr Opin Clin Nutr Metab Care 2002;5:533–537.
• Zorlu M, Helvacı A, Kıskaç M, et al. Silent myocardial isch- emia and related risk factors in patients with type 2 diabetes mellitus. Dicle Med J 2010;37: 140-144.
• Bierbrauer J, Weber-Carstens S. Insulin resistance and pro- tein catabolism in critically ill patients Anasthesiol Inten- sivmed Notfallmed Schmerzther 2011;46:268-74.
• Abosaif NY, Tolba YA, Heap M, et al. The out come of acute renal failure in the intensive care unit according to RIFLE: Model application, sensitivity, and predictability. Am J Kidney Dis 2005;46:1038–1048.
• Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mor- tality in critically İll patients: A cohortanalysis. Crit Care 2006;10:73–83.
• Uchino S, Bellomo R, Goldsmith D, et al. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006;34:1913–1917.
• Finney SJ, Zekveld, Elia A, Evans TW. Glucose control and mortality in critically ill patients. JAMA 2003;290:2041– 2047.
• Wooley JA, Btaiche IF, Good KL. Metabolic and nutritional aspects of acute renal failure in critically ill patients requir- ing continuous renal replacement therapy. Nutr Clin Pract 2005;20:176–191.
• Monson P, Mehta R. Nutritional considerations in continu- ous replacement therapy. Semin Dial 1996;9:152–160.
• Ravindra L, Mehta R. Glycemic Control and Critical Illness: Is the Kidney Involved? J Am Soc Nephrol 2007;18:2623– 2627.
• Jacobs D, Hayes G, Truglia J, Lockwood D. Alterations of glucose transporter systems insulin- resistant uremic rats. Am J Physiol Endocrinol Metab 1989;257:E193–E197.
• Mehta RL, Pascual MT, Soroko S, et al. Spectrum of acute renal failure in the intensive care unit: The PICARD experi- ence. Kidney Int 2004;66:1613–1621.
• Andersen SK, Gjedsted J, Christiansen C, Tonnesen E. The roles of insulin and hyperglycemia in sepsis pathogenesis. J LeukocBiol 2004;75:413–421.
• Himmelfarb J, McMonagle E, Freedman S, et al. Oxidative stress is increased in critically ill patients with acute renal failure. J Am SocNephrol 2004;15:2449–2456.
• Marfella R, Esposito K, Giunta R, et al. Circulating adhe- sion molecules in humans: role of hyperglycemia and hy- perinsulinemia. Circulation 2000;101:2247–2251.
• Seema B, Lara B, Pupi M, Edith M. Simmons. Insulin resis- tance in critically ill patients with acute renal failure. Am J Physiol Renal Physiol 2005;289:259–264.
• Oliver MF, Opie LH. Effects of glucose and fatty acids on myocardial ischaemia and arrythmias. Lancet 1994; 343:155–158.