Impact of RIFLE Classification in Liver Transplantation

Acute renal failure (ARF) is common after orthotopic liver transplantation (OLT). The aim of this study was to evaluate the prognostic value of RIFLE classification in the development of CKD, hemodialysis requirement, and mortality. Patients were categorized as risk (R), injury (I) or failure (F) according to renal function at day 1, 7 and 21. Final renal function was classified according to K/DIGO guidelines. We studied 708 OLT recipients, transplanted between September 1992 and March 2007; mean age 44 +/- 12.6 yr, mean follow-up 3.6 yr (28.8% > or = 5 yr). Renal dysfunction before OLT was known in 21.6%. According to the RIFLE classification, ARF occurred in 33.2%: 16.8% were R class, 8.5% I class and 7.9% F class. CKD developed in 45.6%, with stages 4 or 5d in 11.3%. Mortality for R, I and F classes were, respectively, 10.9%, 13.3% and 39.3%. Severity of ARF correlated with development of CKD: stage 3 was associated with all classes of ARF, stages 4 and 5d only with severe ARF. Hemodialysis requirement (23%) and mortality were only correlated with the most severe form of ARF (F class). In conclusion, RIFLE classification is a useful tool to stratify the severity of early ARF providing a prognostic indicator for the risk of CKD occurrence and death.

Sinergia em Investigação Clínica: Mais do Que a Soma das Partes

A propósito do estudo “Early high calcium and phosphorus intake by parenteral nutrition prevents short-term bone strength decline in preterm infants”, de colaboração entre a UCIN do HDE, os Serviços Farmacêuticos do HDE e estudantes da Licenciatura de Dietética e Nutrição da ESTeSL, foi realçada a vantagem da sinergia multiprofissional multicêntrica em investigação clínica: a investigação foi possível sem depender de financiamento, dado que o dispendioso equipamento de ultrassonografia quantitativa pertence à ESTeSL; a UCIN beneficiou de investigação com a colaboração de investigadores externos (estudantes ESTeSL) dedicados em exclusividade ao projecto; estes, por sua vez, beneficiaram da aprendizagem em investigação de qualidade; o estudo ao ser publicado em revista internacional indexada (J Pediatr Gastroenterol Nutr.), proporcionou o enriquecimento curricular às instituições (HDE e ESTeSL) e aos investigadores (estudantes, médicos e farmacêutica) envolvidos.