{"id":29859,"date":"2023-05-04T17:24:02","date_gmt":"2023-05-04T10:24:02","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29859"},"modified":"2023-05-15T06:16:26","modified_gmt":"2023-05-14T23:16:26","slug":"thang-diem-rifle","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/thang-diem-rifle\/","title":{"rendered":"Thang \u0111i\u1ec3m RIFLE trong t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p"},"content":{"rendered":"

Thang \u0111i\u1ec3m RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) l\u00e0 m\u1ed9t h\u1ec7 th\u1ed1ng \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p d\u1ef1a tr\u00ean c\u00e1c ch\u1ec9 s\u1ed1 huy\u1ebft \u00e1p, l\u01b0u l\u01b0\u1ee3ng d\u1ecbch v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn. \u0110\u01b0\u1ee3c gi\u1edbi chuy\u00ean m\u00f4n s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 quy\u1ebft \u0111\u1ecbnh li\u1ec7u c\u00f3 c\u1ea7n \u0111i\u1ec1u tr\u1ecb th\u1eadn thay th\u1ebf hay kh\u00f4ng. Thang \u0111i\u1ec3m RIFLE cung c\u1ea5p c\u00e1c ti\u00eau chu\u1ea9n cho vi\u1ec7c ph\u00e2n lo\u1ea1i c\u00e1c b\u1ec7nh nh\u00e2n v\u00e0o c\u00e1c nh\u00f3m r\u1ee7i ro kh\u00e1c nhau v\u00e0 gi\u00fap cho c\u00e1c b\u00e1c s\u0129 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 nh\u1ea5t cho t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3<\/strong>.<\/p>\n

1. T\u1ed5ng quan<\/strong><\/h1>\n

N\u0103m 2002, \u00a0Acute Dialysis Quality Initiative (ADQI) \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t ph\u00e2n t\u1ea7ng nguy c\u01a1 bao g\u1ed3m Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) d\u00e0nh cho t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (AKI). S\u1ef1 ph\u00e2n t\u1ea7ng n\u00e0y s\u1ebd cho ph\u00e9p ph\u00e1t hi\u1ec7n c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u1ecb \u1ea3nh h\u01b0\u1edfng nh\u1eb9 (\u0111\u1ed9 nh\u1ea1y cao nh\u01b0ng \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ea5p) v\u00e0 nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng (\u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao nh\u01b0ng \u0111\u1ed9 nh\u1ea1y gi\u1ea3m d\u1ea7n).<\/p>\n

RIFLE l\u00e0 h\u1ec7 th\u1ed1ng ph\u00e2n t\u1ea7ng r\u1ee7i ro AKI \u0111\u1ea7u ti\u00ean. C\u00e1c m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a Risk, Injury v\u00e0 Failure \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh theo m\u1ee9c \u0111\u1ed9 t\u0103ng SCr ho\u1eb7c gi\u1ea3m l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u, t\u00f9y theo m\u1ee9c \u0111\u1ed9 n\u00e0o l\u1edbn h\u01a1n. Loss of kidney function v\u00e0 End stage kidney disease l\u00e0 c\u00e1c nh\u00f3m k\u1ebft qu\u1ea3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh theo th\u1eddi gian m\u1ea5t ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n

RIFLE cho ph\u00e9p ph\u00e2n t\u1ea7ng ti\u00ean l\u01b0\u1ee3ng AKI , \u0111\u1ed3ng th\u1eddi li\u00ean ti\u1ebfp ph\u1ea3n \u00e1nh t\u1ef7 l\u1ec7 t\u1eed vong c\u1ee7a b\u1ec7nh nh\u00e2n ng\u00e0y c\u00e0ng cao h\u01a1n. M\u1ed9t s\u1ef1 gia t\u0103ng g\u1ea7n nh\u01b0 tuy\u1ebfn t\u00ednh v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n \u0111\u00e3 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong m\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u, \u0111\u01a1n trung t\u00e2m c\u1ee7a Uchino et al. Ch\u1ee9ng minh m\u1ed1i t\u01b0\u01a1ng quan v\u1edbi c\u00e1c l\u1edbp RIFLE (b\u00ecnh th\u01b0\u1eddng, 4,4%; Risk, 15,1%; Injury, 29,2%; v\u00e0 Failure, 41,1%), v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 t\u1eed vong cao g\u1ea5p 3 l\u1ea7n so v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng m\u1eafc AKI. T\u1ef7 su\u1ea5t ch\u00eanh c\u1ee7a t\u1ef7 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n l\u00e0 2.5 \u0111\u1ed1i v\u1edbi Risk, 5.4 \u0111\u1ed1i v\u1edbi Injury v\u00e0 10.1 \u0111\u1ed1i v\u1edbi Failure.<\/p>\n

2. Thang \u0111i\u1ec3m RIFLE<\/strong><\/h2>\n
\"\"
Ngu\u1ed3n: Chris Nickson, \u201cRIFLE Criteria and AKIN Classification\u201d<\/strong>, LIFE IN THE FASTLANE, 2020<\/em>.<\/figcaption><\/figure>\n

Th\u1eddi gian c\u1ee7a s\u1ef1 thay \u0111\u1ed5i SCr v\u00e0\/ho\u1eb7c l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u c\u0169ng ph\u00f9 h\u1ee3p \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh AKI, \u0111\u00f3 l\u00e0 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn ph\u1ea3i x\u1ea3y ra \u0111\u1ed9t ng\u1ed9t (1\u20137 ng\u00e0y) v\u00e0 k\u00e9o d\u00e0i (k\u00e9o d\u00e0i >24 gi\u1edd).<\/p>\n

\u0110\u1ecbnh ngh\u0129a n\u00e0y c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng khi \u0111\u00e3 bi\u1ebft m\u1ee9c SCr n\u1ec1n; tuy nhi\u00ean, \u1edf m\u1ed9t s\u1ed1 l\u01b0\u1ee3ng \u0111\u00e1ng k\u1ec3 b\u1ec7nh nh\u00e2n kh\u00f4ng bi\u1ebft SCr n\u1ec1n; trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, n\u1ebfu kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh th\u1eadn m\u00e3n t\u00ednh (CKD), th\u00ec n\u00ean t\u00ednh SCr c\u01a1 b\u1ea3n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng ph\u01b0\u01a1ng tr\u00ecnh (MDRD).<\/p>\n

3. Nh\u1eefng h\u1ea1n ch\u1ebf<\/strong><\/h2>\n
    \n
  • C\u00f4ng c\u1ee5 h\u1ed3i c\u1ee9u \u2014 c\u1ea7n \u0111o l\u01b0\u1eddng c\u00e1c thay \u0111\u1ed5i v\u1ec1 Creatinine v\u00e0 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u theo th\u1eddi gian<\/li>\n
  • C\u1ea7n c\u00f3 Creatinine n\u1ec1n\u2014 ADQI khuy\u1ebfn ngh\u1ecb \u01b0\u1edbc t\u00ednh creatinine d\u1ef1a tr\u00ean c\u00f4ng th\u1ee9c MDRD.<\/li>\n
  • Vi\u1ec7c \u0111\u01b0a v\u00e0o l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc v\u00e0 ph\u00e2n lo\u1ea1i AKI, tuy nhi\u00ean kh\u1ea3 n\u0103ng d\u1ef1 \u0111o\u00e1n c\u1ee7a l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u \u0111\u1ed1i v\u1edbi AKI b\u1ecb c\u1ea3n tr\u1edf b\u1edfi c\u00e1c bi\u1ebfn g\u00e2y nhi\u1ec5u:<\/li>\n
  • Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf \u0111\u00e1ng k\u1ec3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u.<\/li>\n
  • L\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u ch\u1ec9 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1eb7t \u1ed1ng th\u00f4ng ti\u1ec3u v\u00e0 y\u00eau c\u1ea7u c\u00e1c ph\u00e9p \u0111o trong kho\u1ea3ng th\u1eddi gian 6 gi\u1edd v\u00e0 12 gi\u1edd k\u1ec3 t\u1eeb khi nh\u1eadp vi\u1ec7n.<\/li>\n
  • Ngo\u00e0i l\u1ecdc, b\u00e0i ti\u1ebft qua \u1ed1ng th\u1eadn chi\u1ebfm 10-40% th\u1ea3i tr\u1eeb creatinine, d\u1eabn \u0111\u1ebfn \u0111\u00e1nh gi\u00e1 qu\u00e1 cao ch\u1ee9c n\u0103ng th\u1eadn \u1edf b\u1ec7nh nh\u00e2n AKI n\u1ebfu ch\u1ec9 \u0111\u00e1nh gi\u00e1 eGFR.<\/li>\n
  • SCr s\u1ebd t\u0103ng khi gi\u1ea3m b\u00e0i ti\u1ebft creatinine \u1edf \u1ed1ng th\u1eadn, kh\u00f4ng li\u00ean quan \u0111\u1ebfn thay \u0111\u1ed5i ch\u1ee9c n\u0103ng th\u1eadn. S\u1ef1 gi\u1ea3m n\u00e0y c\u00f3 th\u1ec3 do c\u00e1c lo\u1ea1i thu\u1ed1c th\u00f4ng d\u1ee5ng nh\u01b0 Trimethoprim v\u00e0 Cimetidine g\u00e2y ra.<\/li>\n
  • \u0110\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a c\u00e1c ph\u00e9p \u0111o l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u.<\/li>\n
  • Ph\u00e2n lo\u1ea1i RIFLE kh\u00f4ng t\u00ednh \u0111\u1ebfn nguy\u00ean nh\u00e2n c\u1ee7a AKI v\u00e0 nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn (RRT) v\u00e0 l\u1ecdc m\u00e1u.<\/li>\n
  • L\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi nhi\u1ec1u y\u1ebfu t\u1ed1 nh\u01b0: s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u , \u0111\u00e1p \u1ee9ng ADH, \u0111\u00e1i th\u00e1o nh\u1ea1t<\/li>\n
  • Creatinine n\u1ec1n c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi v\u1ea5n \u0111\u1ec1 b\u1ec7nh \u0111\u1ed3ng m\u1eafc c\u1ee7a b\u1ec7nh nh\u00e2n, v\u00ed d\u1ee5: n\u00f3 c\u00f3 th\u1ec3 t\u0103ng gi\u1ea3 khi b\u1ec7nh nh\u00e2n b\u1ecb m\u1ea5t n\u01b0\u1edbc l\u00fac nh\u1eadp vi\u1ec7n.<\/li>\n
  • Kh\u00f4ng r\u00f5 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u v\u00e0 creatinine \u1ed5n \u0111\u1ecbnh nh\u01b0 th\u1ebf n\u00e0o m\u1eb7c d\u00f9 \u0111i\u1ec1u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c cho gi\u00e1 tr\u1ecb b\u1eb1ng nhau (RIFLE s\u1eed d\u1ee5ng creatinine c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong cao h\u01a1n so v\u1edbi s\u1eed d\u1ee5ng l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u)<\/li>\n
  • Nh\u1eefng thay \u0111\u1ed5i nh\u1ecf h\u01a1n v\u1ec1 creatinine so v\u1edbi nh\u1eefng thay \u0111\u1ed5i \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong ph\u00e2n lo\u1ea1i nguy c\u01a1 (v\u00ed d\u1ee5: Cr t\u0103ng 0.3 mg\/dl) c\u00f3 li\u00ean quan \u0111\u1ebfn k\u1ebft qu\u1ea3 t\u1ed3i t\u1ec7 h\u01a1n.<\/li>\n<\/ul>\n

    Cu\u1ed1i c\u00f9ng, ph\u00e2n lo\u1ea1i RIFLE kh\u00f4ng cung c\u1ea5p b\u1ea5t k\u1ef3 th\u00f4ng tin n\u00e0o li\u00ean quan \u0111\u1ebfn ngu\u1ed3n g\u1ed1c c\u1ee7a t\u1ed5n th\u01b0\u01a1ng th\u1eadn (t\u1ee9c l\u00e0 c\u1ea5p \u0111\u1ed9 t\u1ebf b\u00e0o ho\u1eb7c d\u01b0\u1edbi t\u1ebf b\u00e0o), tr\u00e1i ng\u01b0\u1ee3c v\u1edbi m\u1ed9t s\u1ed1 d\u1ea5u \u1ea5n sinh h\u1ecdc c\u1ee7a AKI \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh v\u00e0 nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y. H\u01a1n n\u1eefa, nh\u1eefng h\u1ea1n ch\u1ebf c\u1ee7a c\u00e1c d\u1ea5u hi\u1ec7u ch\u1ee9c n\u0103ng th\u1eadn th\u00f4ng th\u01b0\u1eddng (Cr v\u00e0 UO) c\u00f3 th\u1ec3 b\u1ecb l\u1ea5n \u00e1t khi s\u1eed d\u1ee5ng c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc m\u1edbi \u0111\u00f3. Tr\u00ean th\u1ef1c t\u1ebf, nhi\u1ec1u d\u1ea5u hi\u1ec7u huy\u1ebft thanh v\u00e0 n\u01b0\u1edbc ti\u1ec3u kh\u00e1c nhau c\u1ee7a AKI \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh v\u00e0 m\u00f4 t\u1ea3, ch\u1eb3ng h\u1ea1n nh\u01b0 lipocalin li\u00ean quan \u0111\u1ebfn gelatinase trung t\u00ednh, interleukin-18 v\u00e0 ph\u00e2n t\u1eed t\u1ed5n th\u01b0\u01a1ng th\u1eadn-1. C\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc n\u00e0y b\u1eaft \u0111\u1ea7u t\u0103ng s\u1edbm trong AKI (1\u20133 ng\u00e0y tr\u01b0\u1edbc khi t\u0103ng SCr) v\u00e0 th\u1ec3 hi\u1ec7n \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao trong ch\u1ea9n \u0111o\u00e1n AKI, t\u01b0\u01a1ng quan t\u1ed1t v\u1edbi y\u00eau c\u1ea7u RRT, c\u0169ng nh\u01b0 t\u1ef7 l\u1ec7 t\u1eed vong, trong m\u1ed9t s\u1ed1 b\u1ed1i c\u1ea3nh, c\u1ee5 th\u1ec3 l\u00e0 trong giai \u0111o\u1ea1n h\u1eadu ph\u1eabu c\u1ee7a ph\u1eabu thu\u1eadt tim, \u1edf b\u1ec7nh nh\u00e2n ICU v\u00e0 trong b\u1ec7nh th\u1eadn do thu\u1ed1c c\u1ea3n quang \u1edf tr\u1ebb em \u0111\u01b0\u1ee3c ch\u1ee5p m\u1ea1ch v\u00e0nh. Trong gh\u00e9p th\u1eadn, ng\u01b0\u1eddi ta \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng nh\u1eefng d\u1ea5u \u1ea5n sinh h\u1ecdc n\u00e0y c\u0169ng c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan t\u1ed1t v\u1edbi th\u1eddi gian thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 l\u1ea1nh, gi\u00e1 tr\u1ecb t\u1ed1i \u0111a c\u1ee7a SCr trong giai \u0111o\u1ea1n sau gh\u00e9p v\u00e0 y\u00eau c\u1ea7u RRT, v\u00e0 l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o t\u1ed1t v\u1ec1 ho\u1ea1i t\u1eed \u1ed1ng c\u1ea5p t\u00ednh v\u00e0 th\u1eddi gian d\u00e0i h\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn gh\u00e9p.<\/p>\n

    C\u0169ng ph\u1ea3i nh\u1ea5n m\u1ea1nh r\u1eb1ng ti\u00eau ch\u00ed RIFLE m\u1edbi ch\u1ec9 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u1edf m\u1ed9t s\u1ed1 \u00edt (<2%) b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o c\u00e1c nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u. Nh\u01b0\u1ee3c \u0111i\u1ec3m ch\u00ednh n\u00e0y ch\u1eafc ch\u1eafn \u0111\u00e3 h\u1ea1n ch\u1ebf vi\u1ec7c ph\u00e2n t\u00edch c\u00e1c bi\u1ebfn l\u00e2m s\u00e0ng ho\u1eb7c x\u00e9t nghi\u1ec7m kh\u00e1c c\u00f3 t\u00e1c \u0111\u1ed9ng ti\u00ean l\u01b0\u1ee3ng \u0111\u1ed1i v\u1edbi d\u1ecbch t\u1ec5 h\u1ecdc c\u1ee7a t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p.<\/p>\n

    Ngu\u1ed3n tham kh\u1ea3o<\/strong>:<\/p>\n

    Jos\u00e9 Ant\u00f3nio Lopes, Sofia Jorge, \u201cThe RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review\u201d, Clinical Kidney Journal, Volume 6, Issue 1, February 2013, Pages 8\u201314.<\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Thang \u0111i\u1ec3m RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) l\u00e0 m\u1ed9t h\u1ec7 th\u1ed1ng \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p d\u1ef1a tr\u00ean c\u00e1c ch\u1ec9 s\u1ed1 huy\u1ebft \u00e1p, l\u01b0u l\u01b0\u1ee3ng d\u1ecbch v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn. \u0110\u01b0\u1ee3c gi\u1edbi chuy\u00ean m\u00f4n s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 quy\u1ebft \u0111\u1ecbnh li\u1ec7u c\u00f3 c\u1ea7n […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\nThang \u0111i\u1ec3m RIFLE trong t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p<\/title>\n<meta name=\"description\" content=\"Thang \u0111i\u1ec3m RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) l\u00e0 m\u1ed9t 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