The purpose of this study is to compare two methods of classifying acute kidney injury (AKI), the Risk, Injury, Failure, Loss, End stage (RIFLE) and serum creatinine (SCr-AKI) methods, based on their predictive capacities in lung transplant recipients.
Methods: 1050 lung transplant cases were included in the study. RIFLE-AKI was determined by comparing baseline glomerular filtration rate (GFR) with minimum GFR in the first week after transplant. Similar to the National Surgical Quality Improvement Program (NSQIP) method, SCr-AKI was classified as serum creatinine > 3 mg/dL, also in the first week after transplant. Logistic regression models analyzed the effect of AKI on outcomes with SCr-AKI modeled as a binary variable: Y/N and RIFLE-AKI modeled as an ordinal variable: No AKI = 0, Risk = 1, Injury = 2, Failure = 3 and Loss/End-stage = 4.
Results: On univariate analysis, both RIFLE-AKI and SCr-AKI were associated with elevated risk for early outcomes including sepsis and 30-day mortality (p < 0.0001). Relationships remained significant after adjusting for comorbidities and demographic factors (p < 0.0002). Similarly, both methods were associated with risk for late outcomes including stage-4 chronic kidney disease (CKD-4), dialysis, and death at 1, 3, and 5 years (p < 0.0001). On multivariate analysis, RIFLE-AKI remained a predictor for CKD-4 (OR = 1.7, [95% CI = 1.2, 2.7]), dialysis (OR = 3.1, [2.2 4.3]) and 1-year mortality (OR = 1.5, [1.1 2.0]). SCr-AKI retained significance for associations with CKD-4 (OR = 6.5, [2.4 17.3]), dialysis (OR = 14.3, [7.6 27.1]), 1-year mortality (OR = 4.7, [2.4 9.4]), and 3-year mortality (OR = 2.2, [1.1 4.4]).
Conclusion: Whether it is calculated using the RIFLE or creatinine-only method, acute kidney injury after lung transplantation predicts worse outcomes. The RIFLE method provides more granularity and enhances the predictive capacity at lower levels of kidney injury.
To cite this abstract in AMA style:Osho A, Castleberry A, Snyder L, Palmer S, Lin S, Davis R, Hartwig M. Outcomes in Lung Transplantation: The RIFLE Classification Optimizes the Predictive Utility of Post-Transplant Acute Kidney Injury as a Determinant of Early and Late Outcomes [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/outcomes-in-lung-transplantation-the-rifle-classification-optimizes-the-predictive-utility-of-post-transplant-acute-kidney-injury-as-a-determinant-of-early-and-late-outcomes/. Accessed May 5, 2021.
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