Nergiz BAYRAKÇI, Sibel ERSAN, Ali ÇELİK, Taner ÇAMSARI, Hakan Alp BODUR, Aykut SİFİL

Yoğun Bakım Hastalarında Akut Böbrek Hasarı ve Mortalite İlişkisinin Belirlenmesinde RIFLE, AKIN ve KDIGO Kriterlerinin Yeri

Amaç: Akut böbrek hasarının (ABH) daha kesin biçimde tanımlanması ve takip sürecinin daha iyi yönetilmesi amacıyla çok sayıda sınıflama gündeme gelmiştir. Bunlar arasında en yaygın kabul görenler risk, injury, failure, loss, and end stage (RIFLE), acut kidney injury network (AKIN) ve kidney disease: Improving global outcomes (KDIGO) sınıflamaları olmuştur. Bu çalışmada, yoğun bakımda izlenen ve ABH tanısı alan hastalarda RIFLE, AKIN ve KDIGO kriterlerine göre ABH şiddeti ile mortalite arasındaki ilişkinin saptanması amaçlanmıştır. Gereç ve Yöntem: Dahiliye yoğun bakım ünitesinde izlenen 1.491 hastaya ait veriler retrospektif olarak incelendi ve ABH saptanan hastalar çalışmaya dahil edildi. Tüm hastalar için RIFLE, AKIN ve KDIGO kriterlerine kullanılarak ABH şiddeti belirlendi. Bulgular: Çalışmaya 155 hasta dahil edildi. RIFLE kriterlerine göre risk, hasar, yetmezlik evrelerinde yer alan hasta oranları sırasıyla; %14,8, %40,0, %45,2; AKIN kriterlerine göre evre 1, evre 2 ve evre 3’te yer alan hasta oranları sırasıyla; %45,6, %30,6, %23,8; KDIGO kriterlerine göre evre 1, evre 2 ve evre 3’te yer alan hasta oranları sırasıyla; %18,7, %21,7, %54,1 idi. AKIN ve RIFLE kriterlerine göre belirlenen ABH evreleri arasında mortalite oranları açısından farklılık saptanmazken, KDIGO evre 3’te yer alan hastalarda evre 1 ve evre 2 ABH gruplarına göre mortalite daha yüksek saptandı. Sonuç: Her üç tanı ve evreleme sistemi de ABH etiyolojisini dikkate almamaktadır. Bu nedenle mortalite ve ABH şiddeti arasındaki ilişkiyi doğru yansıtmamaları söz konusu olabilir. Bununla birlikte, kendisinden önce kullanılan evreleme sistemlerindeki eksikliklerden doğan ihtiyaçla ortaya çıkan KDIGO evreleme sistemi bu açıdan daha geçerli görünmektedir.

The Role of RIFLE, AKIN and KDIGO Criteria in Determining the Relationship Between Acute Kidney Injury and Mortality in Intensive Care Patients

Aim: Risk, injury, failure, loss, and end stage (RIFLE); acute kidney injury network (AKIN) and kidney disease: Improving global outcomes (KDIGO) classifications are the most commonly used criteria for the diagnosis of acute kidney injury (AKI). The aim of our study was to determine the relationship between the mortality and the severity of AKI diagnosed by using RIFLE, AKIN, and KDIGO classifications in critically ill patients. Materials and Methods: Data of 1,491 patients hospitalized in tertiary intensive care unit were retrieved from electronic medical records and patients diagnosed with AKI were included in the study. AKI severity was determined according to the RIFLE, AKIN, and KDIGO classifications. Results: One hundred fifty-five patients were included in the study. The percentages of patients in risk, damage, and failure stages according to the RIFLE criteria were 14.8%, 40.0%, and 45.2%, respectively. The percentages in stage 1, 2 and 3 were 45.6%, 30.6%, and 23.8% according to the AKIN criteria and 18.7%, 21.7%, and 54.1% according to the KDIGO criteria, respectively. There was a difference in mortality between the stages of AKI determined according to the AKIN and RIFLE criteria. Mortality was found to be higher in patients in KDIGO stage 3. Conclusion: These three classifications do not consider the etiology of AKI. Therefore, it may be possible that they do not accurately reflect the relationship between mortality and AKI severity. However, the KDIGO classification, which emerged with the need arising from the inadequacy of the classifications used before it, seems to be more valid in this respect.

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