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An assessment of the RIFLE criteria for acute renal failure following myeloablative autologous and allogeneic haematopoietic cell transplantation

Bone Marrow Transplantation volume 38, page 395 (2006)Cite this article

RIFLE is a newly developed classification for acute renal failure (ARF) that defines three grades of severity – Risk (class R), Injury (class I) and Failure (class F).1 Although a few studies applied this scoring system in the set of critically ill patients,2, 3, 4 its usefulness in the patient submitted to haematopoietic cell transplantation (HCT) has not yet been assessed. We sought to evaluate the accuracy of RIFLE classification to predict mortality in the HCT patients who received a myeloablative autologous or allogeneic HCT in our hospital between January 2003 and December 2004. Patients were categorized on serum creatinine or urinary output, or both, and the criteria that lead to the worst classification were used. Class R was considered if there was an increase of serum creatinine × 1.5 or an urinary output lower than 0.5 ml/kg/h for 6 h; Class I if there was an increase of serum creatinine × 2 or an urinary output lower than 0.5 ml/kg/h for 12 h; and class F if there was an increase of serum creatinine × 3 or serum creatinine was higher than 4 mg/dl, or an urinary output lower than 0.3 ml/kg/h for 24 h, or anuria for 12 h. One hundred and forty patients (86 men, mean age: 32.9±14.69 years) were evaluated – 90 patients had an allogeneic HCT and 50 an autologous HCT; 82 patients received a peripheral blood stem cell transplantation and 58 a bone marrow graft. Mortality rate was 15.7%. According to the RIFLE criteria, 13.5% of all patients were in the class R for ARF, 10% in the class I, and 14.3% in the class F. Mortality increased significantly from Normal to class F (Normal, 4.5%; class R, 5.2%; class I, 42%; and class F, 55%; P<0.0001). Forward stepwise multivariate regression analysis showed that class R (RR 3.9, 95% CI 1–15, P<0.0001) and class I (RR 4.5, 95% CI 0.5–40.9, P=0.006) were associated with a significantly higher risk of death than patients with normal renal function. RIFLE criteria allowed us to identify close to 38% of HCT patients as having various degrees of ARF, and appears to be an important tool to stratify these patients according to the risk of death.

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Authors and Affiliations

  1. Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Lisboa, Portugal

    J A Lopes, S Jorge, S Silva, E de Almeida, F Abreu & M M Prata

  2. Department of Hematology, Hospital de Santa Maria, Lisboa, Portugal

    C Martins, J A do Carmo & J F Lacerda

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  1. J A Lopes
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  2. S Jorge
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  3. S Silva
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  4. E de Almeida
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  5. F Abreu
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  6. C Martins
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  7. J A do Carmo
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  8. J F Lacerda
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  9. M M Prata
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Correspondence to J A Lopes.

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Lopes, J., Jorge, S., Silva, S. et al. An assessment of the RIFLE criteria for acute renal failure following myeloablative autologous and allogeneic haematopoietic cell transplantation. Bone Marrow Transplant 38, 395 (2006). https://doi.org/10.1038/sj.bmt.1705461

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