Background: Risk, Injury, Failure, Loss, and End-Stage (RIFLE) criteria have been proposed as a standard definition of acute kidney injury (AKI). The most severe form of AKI, class F AKI, can be defined by either severe oliguria or a 3-fold increase in serum creatinine concentrations. We hypothesized that the outcomes of patients with these 2 alternative criteria of severe AKI were different. Methods: A prospective cohort study was conducted of all patients attaining RIFLE class F AKI during a 12-month period in a tertiary critical care facility. Results: Among a total of 2,379 critical care admissions, 129 (5.4%) fulfilled the serum creatinine criteria without oliguria (RIFLE class F) and 99 (4.2%) fulfilled oliguric (RIFLE class F) AKI criteria. Patients with oliguric AKI suffered a more severe disease process than nonoliguric AKI. Oliguric AKI was associated with a significantly higher risk of requiring acute dialysis (70.7 vs. 22.4%, p = 0.001), long-term dialysis >90 days (15 vs. 1.9%, p = 0.006), and hospital mortality (adjusted hazard ratio 3.33, 95% confidence interval, p = 0.001) than nonoliguric AKI. Conclusions: Oliguric RIFLE class F AKI is a more severe form of AKI than nonoliguric class F AKI. These 2 forms of AKI should be considered separately when AKI is evaluated in a clinical trial.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, ADQI Workgroup: Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204–R212.
Anderson RJ, Linas SL, Berns AS, Henrich WL, Miller TR, Gabow PA, Schrier RW: Nonoliguric acute renal failure. N Engl J Med 2007;296:1134–1138.
Diamond JR, Yoburn DC: Nonoliguric acute renal failure. Arch Intern Med 1982;142:1882–1884.
Frankel MC, Weinstein AM, Stenzel KH: Prognostic patterns in acute renal failure: the New York Hospital, 1981–1982. Clin Exp Dial Apheresis 1983;7:145–167.
Dixon BS, Anderson RJ: Nonoliguric acute renal failure. Am J Kidney Dis 1985;6:71–80.
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006;10:R73.
Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C: An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006;34:1913–1917.
Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM: The outcome 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.
Maccariello E, Soares M, Valente C, Nogueira L, Valença RV, Machado JE, Rocha E: RIFLE classification in patients with acute kidney injury in need of renal replacement therapy. Intensive Care Med 2007;33:597–605.
Bellomo R, Kellum JA, Ronco C: Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med 2007;33:409–413.
de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F: Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000;26:915–921.
Ho KM, Sheridan DJ: Meta-analysis of frusemide to prevent or treat acute renal failure. BMJ 2006;333:420.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C, Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813–818.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committee: A comparison of the RIFLE and AKIN criteria for acute kidney injury in the critically ill patients. Nephrol Dial Transplant 2008;23:1569–1574.
Joannidis M, Metnitz, Bauer P, Schusterschitz N, Moreno R, Druml W, Metnitz PG: Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 2009;35:1692–1702.
Chang CH, Lin CY, Tian YC, Jenq CC, Chang MY, Chen YC, Fang JT, Yang CW: Acute kidney injury classification: comparison of AKIN and RIFLE criteria. Shock 2009, E-pub ahead of print.
Bagshaw SM, George C, Dinu I, Bellomo R: A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1203–1210.
Bagshaw SM, George C, Gibney RT, Bellomo R: A multi-center evaluation of early acute kidney injury in critically ill trauma patients. Ren Fail 2008;30:581–589.
Mehta RL: Fluid balance and acute kidney injury: the missing link for predicting adverse outcomes? Nat Clin Pract Nephrol 2009;5:10–11.
Liano F, Felipe C, Tenorio MT, Rivera M, Abraira V, Saez-de-Urturi JM, Ocana J, Fuentes C, Severiano S: Long-term outcome of acute tubular necrosis: a contribution to its natural history. Kidney Int2007;71:679–686.
Schiffl H, Fischer R: Five-year outcomes of severe acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant 2008;23:2235–2241.
Uchino S, Bellomo R, Kellum JA, Morimatsu H, Morgera S, Schetz MR, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-Van Straaten HM, Ronco C, Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators Writing Committee: Patient and kidney survival by dialysis modality in critically ill patients with acute kidney injury. Int J Artif Organs 2007;30:281–292.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.