RIFLE is not RIFLE on the comparability of results 英文参考文献.docVIP

Available online /content/13/6/429 Letter RIFLE is not RIFLE: on the comparability of results Lars Englberger, Rakesh M Suri and Hartzell V Schaff Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA Corresponding author: Lars Englberger, lars.englberger@insel.ch Published: 9 December 2009 Critical Care 2009, 13:429 (doi:10.1186/cc8175) This article is online at /content/13/6/429 ? 2009 BioMed Central Ltd In the consensus RIFLE criteria [1] of acute kidney injury (AKI) the thresholds given for serum creatinine (sCr) increase and glomerular filtration rate (GFR) decrease (Table 1) do not correspond [2]. Direct measurement of GFR in clinical practice is difficult, and values are more often estimated (eGFR) by the Cockroft-Gault equation or the Modification of Diet in Renal Disease (MDRD) formula. In addition, there is controversy in the literature whether eGFR provides more clinical information regarding AKI than changes in sCr [3]. Table 1 RIFLE criteria for the definition of acute kidney injury (urinary output criteria not listed) RIFLE class R (risk) RIFLE criteria ≥1.5-fold increase in serum creatinine, or 25% decrease in GFR I (injury) ≥2-fold increase in serum creatinine, or 50% decrease in GFR As an example of the possible discrepancy, a 1.5-fold increase (50%) in sCr from a baseline of 1.0 mg/dL in a 60- year-old white male corresponds to only a 37% eGFR decrease using the MDRD formula. In this scenario the patient is classified in RIFLE class R by both methods. In the same patient an only 30% increase in sCr (1.0 mg/dL to 1.3 mg/dL), however, corresponds to a 26% decrease of F (failure) ≥3-fold increase in serum creatinine, or 75% decrease in GFR Furthermore, the use of different versions of RIFLE criteria counteracts the original goal of a consensus definition and hinders comparability. eG