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Outcome of patients with acute renal failure in an intensive care unit using RIFLE criteria in South Africa

BACKGROUND: Acute renal failure (ARF) is a clinical syndrome characterised by a rapid deterioration of kidney function over hours to days which may recover/return to normal values following appropriate therapy. Various scoring systems currently exist to predict the severity and outcome in patients with ARF. Recently the Acute Dialysis Quality Initiative (ADQI) Group has established the RIFLE (Risk of injury, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage kidney disease) classification which has become widely used globally. There is however, limited data on its use in Africa.
In order to provide data on the use of RIFLE criteria from an African facility, we conducted a retrospective chart review to assess the outcome of ARF in patients admitted in the Intensive Care Unit (ICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The data reviewed covered the period between January 1st to December 31st 2008.
METHODS: This was a retrospective chart review conducted in the adult multi-disciplinary intensive care unit at CMJAH between January 1st to December 31st 2008. Medical records of patients admitted during this period were reviewed and patients with acute renal failure were identified. Demographic data, relevant clinical information such as reason for ICU admission, number of organ(s) involved, presence of co-morbidity, RIFLE criteria on admission and on discharge, modality and duration of treatment of ARF, need for mechanical ventilation and or inotropic support were recorded. For the purpose of this study, serum creatinine based on RIFLE classification was used to define ARF. Statistical analysis was performed using the data collected and STATA version 11. The Primary outcome, which was survival or death, was correlated with the maximum RIFLE classification during patients’ ICU stay. The study was approved by the Human Research Ethics Committee medical (HRECM) of the University of Witwatersrand with Clearance certificate number M090906
RESULTS: One hundred and ninety three (193) patients with acute renal failure were included in the study. The mean APACHE II score was 19 ± 6.4 SD, with the maximum score documented being 38. Patient ages ranged from 21 – 92 years with a mean of 50.5 years ± 18.3SD. Fifty two percent of the patients were male and 48% were female. Majority of patients were black (63%) with 36.8% being other race groups.
According to RIFLE criteria on admission, 40.9% had normal renal function, 23.3%, 14.0% and 21.8% were in RIFLE R, I and F classes respectively. The overall mortality in ICU was 59.9%. Of those patients discharged to the ward from ICU, 14.1% subsequently demised. Factors associated with mortality in ICU included race, chronic pulmonary disease, mechanical ventilation, inotropic support, need for ventilation and inotropic support, dialysis and maximum RIFLE criteria reached in ICU. After multivariate analysis using Cox proportion regression model, factors such as race, inotropic support, need for both ventilation and inotropic support and maximum RIFLE criteria were independently associated with mortality in ICU, whereas for patients discharged from ICU to the ward, only cancer was found to be independently associated with mortality. Based on RIFLE criteria, patients in R, I, and F class had 5.41, 3.17 and 5.69 greater risk of dying respectively as compared to patients with normal renal function (Adjusted HR 5.41 95%CI 2.66 - 11.0, p-Value 0.000 for R class, HR 3.17 95%CI 1.65 - 6.07, p-value 0.001for I class, and HR 5.69 95%CI 2.93 - 11.06, p-value 0.001 for F class) CONCLUSION: RIFLE criteria is a useful tool for predicting the outcome of acute renal failure in the intensive care unit.
Date04 March 2013
CreatorsMujwahuzi, Leodegard
Source SetsSouth African National ETD Portal
Detected LanguageEnglish
TypeThesis (M.Med.(Internal Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2012

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