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Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): a comparative analysis
  1. Tauqeer Hussain Mallhi1,
  2. Amer Hayat Khan1,
  3. Azmi Sarriff1,
  4. Azreen Syazril Adnan2,
  5. Yusra Habib Khan1,
  6. Fauziah Jummaat3
  1. 1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
  2. 2Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kota Baru, Kelantan, Malaysia
  3. 3Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, University Sains Malaysia, Kota Baru, Kelantan, Malaysia
  1. Correspondence to Dr Tauqeer Hussain Mallhi, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang 11800, Malaysia; tauqeer.hussain.mallhi{at}hotmail.com

Abstract

Background Several criteria have been used to stratify acute kidney injury (AKI) in dengue infection and have resulted in variations in its incidence as well as clinic-laboratory characteristics. The current study was aimed to compare three commonly used criteria of AKI among patients with dengue.

Methods 667 patients with dengue were defined and staged according to the conventional definition (CD), the Acute Kidney Injury Network (AKIN) and the Risk, Injury, Failure, Loss of function, End stage renal disease (RIFLE) criteria. Appropriate statistical methods were used to compare these three criteria.

Results The incidence of AKI during dengue infection was 14.2% by AKIN criteria, 12.6% by RIFLE criteria and 4.2% by CD. AKIN and RIFLE criteria were comparable while AKIN-I identified 11 more patients with AKI than RIFLE-R (76.8% vs 73.8%, p=0.023). CD was found to be less sensitive than AKIN and RIFLE due to stratification of only severe AKI cases with serum creatinine ≥176.8 µmol/L. Overall mortality was 1.2% and severe stages of AKI were associated with increased mortality (p<0.001). AKIN criteria identified seven risk factors, RIFLE identified six and CD identified three risk factors. Old age, severe dengue and the use of nephrotoxic drugs were found to be independent predictors identified by all criteria while hypertension was only identified by AKIN.

Conclusions The incidence of AKI in dengue infection, the risk factors for its development and clinico-laboratory characteristics vary significantly according to the diagnostic criteria used. In our analysis, AKIN and RIFLE were comparable to each other and superior to CD with regard to early diagnosis and sensitivity.

  • INFECTIOUS DISEASES

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