title: RIFLE criteria for acute kidney dysfunction following heart transplantation: incidence and risk factors.
abstract: OBJECTIVE
  There are few data regarding the occurrence of (RIFLE)-based acute kidney dysfunction (AKD) after heart transplantation (HT) and its risk factors. The aim of this study was to apply RIFLE criteria in patients who developed AKD following HT to compare patients with and without AKD and to determine incidence and risk factors of AKD.
  
  
  METHODS
  We retrospectively analyzed the records of 65 patients who underwent HT between 2003 and 2012. We investigated 3 levels of renal dysfunction outlined in RIFLE criteria: risk (R), injury (I), and failure (F). Appropriate class was assigned comparing baseline creatinine level to peak levels in the first 7 days after HT. Perioperative variables of heart transplant recipients were collected.
  
  
  RESULTS
  The mean age at transplantation was 32.8 ± 16.6 years with 72.7% males. The incidence of AKD was 61%, risk occured in 18%, injury in 16%, and failure in 27% of the patients. Patients who had AKD were significantly older (37.9 ± 15.6 vs 24.6 ± 15.0 years: P = .008), had higher body mass index (24.7 ± 6.7 vs 18.6 ± 4.3; P = .002), and more frequently had history of hypertension (92% vs 8%; P = .011) and smoking (100% vs 0%; P = .008) when compared with those who did not have AKD. When compared with patients who did not develop AKD postoperatively, preoperative higher creatinine levels (1.1 ± 0.3 vs 0.8 ± 0.4; P = .025), intraoperative higher mean arterial pressures (99.2 ± 14.1 vs 89.0 ± 11.4 mm Hg; P = .011), a higher frequency of intraoperative acidosis (81% vs 19%; P = .041), higher lactate levels (5.1 ± 3.8 vs 2.8 ± 1.7 mmol/L; P = .038), and postoperative more frequent use of cyclosporine (91% vs 9%; P = .025) were seen in those who developed AKD. Logistic regression analysis revealed that age (odds ratio [OR], 1.057; 95% confidence interval [CI], 1.010-1.106; P = .018) and use of cyclosporine (OR, 0.099; 95% CI, 0.010-0.935; P = .043) were independent risk factors for AKD.
  
  
  CONCLUSIONS
  Our results suggest that based on RIFLE criteria, AKD occur in more than half of HTs postoperatively. Older age and use of cyclosporine are associated with AKD following HT.
authors: Department of Anesthesiology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors: M
authors: M
authors: Türker
authors: P
authors: P
authors: Zeyneloglu
authors: A
authors: A
authors: Sezgin
authors: A
authors: A
authors: Pirat
authors: G
authors: G
authors: Arslan
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine