improving. To address this issue, the Acute Dialysis Quality Initiative (ADQI)
Group, (a multidisciplinary group working on developing evidence-based
guidelines for the treatment of ARF), identified specific characteristics to help
define and measure outcomes of renal failure. [18]
According to ADQI guidelines, the acute deterioration of kidney function follows a
series of steps to finally reach a complete and permanent cessation of renal
function. These are known as the RIFLE criteria for acute renal dysfunction and
are represented by a progressive declining of the UO and GFR, and increasing
plasma creatinine. (Fig. 2)
R= Risk of renal dysfunction
I= Injury to the kidney
F= Failure of kidney function
L= Loss of kidney function. Indicates persistent loss requiring RRT for more than
4 weeks
E= End stage kidney disease. Indicates need for RRT for more than 3 months.
The correlation of the RIFLE criteria with outcomes from renal failure has been
investigated in depth. The initiation of RRT in early stages or “less severe” renal
failure (RIFLE-R, RIFLE-I) has been associated with improved outcomes and
decreased 30 day mortality. In contrary, when RRT was initiated in more severe
stages (RIFLE-F, RIFLE-L), the 30 day mortality approached almost 50%. [27]
Unfortunately, a recent review demonstrated that the RIFLE criteria were
inconsistent when used to determine the morbidity and mortality outcomes in
children with renal failure. [28]