Elsevier

Critical Care Clinics

Volume 21, Issue 2, April 2005, Pages 239-249
Critical Care Clinics

Epidemiology and Natural History of Acute Renal Failure in the ICU

https://doi.org/10.1016/j.ccc.2004.12.005Get rights and content

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Acute renal failure in critically ill patients: prevalence and cause

A different situation is found in the special population of critically ill patients. Prevalences reported for ARF in ICUs generally are greater and range from 3% to 25%, depending on the criteria applied [4], [12], [13], [14], [15], [16], [17]. A study that investigated the prevalence of ARF in 13 tertiary care hospitals in Madrid, Spain, found that 34% of the 748 episodes of ARF occurred in ICU settings. Ischemic ATN seemed to be the predominant reason for ARF in this group (78%), followed by

Risk adjustment in patients who have acute renal failure

Although general severity-of-illness scores, such as the Simplified Acute Physiology Score (SAPS) II [26], were developed for use in assessing severity of illness in a mixed ICU population, they have been applied often to specific subgroups, such as patients who have ARF [17], [27], [28], [29], [30], [31], [32], [33]. These systems have been reported as risk-stratifying tools (eg, for clinical studies) and are said to aid in the detection of futile care [34]. Only a few studies have tried to

Outcome of critically ill patients who have acute renal failure

Reported ICU and hospital mortality vary between 20% and 80% (Table 1) [9], [13], [18], [25], [49]. There is some debate about whether an attributable excess mortality also exists in mild ARF. Mild ARF, defined as less than a 50% increase in baseline serum creatinine values in patients who have normal or slightly impaired baseline renal function, is not associated with significant long-term sequelae, as shown in an observational study of 916 patients [50]. Although that study suggested that

Long-term outcome in ICU survivors

Although in-hospital survival of critically ill patients is poor and rarely exceeds 30%, long-term survival of patients who leave the hospital is not as bad. After discharge from the hospital, approximately 10% to 30% of patients need further dialysis treatment [28], [29], [49]. In a German study that investigated 979 patients in the ICU [57], the 6-month survival of patients who survived to hospital discharge was approximately 69%; 5-year survival was 50%. Only 10% required chronic dialysis;

Summary

ARF in the ICU is associated with an extremely high mortality. Accurate epidemiologic assessment of ARF, however, remains a problem; as long as there is neither a generally accepted definition of ARF, nor definitions for end points to measure, assessments likely will vary according to local criteria [59].

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References (59)

  • R.L. Mehta et al.

    Spectrum of acute renal failure in the intensive care unit: the PICARD experience

    Kidney Int

    (2004)
  • S. Morgera et al.

    Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies

    Am J Kidney Dis

    (2002)
  • T.G. Feest et al.

    Incidence of severe acute renal failure in adults: results of a community based study

    BMJ

    (1993)
  • W. Metcalfe et al.

    Acute renal failure requiring renal replacement therapy: incidence and outcome

    QJM

    (2002)
  • F. Liano et al.

    The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. Madrid Acute Renal Failure Study Group

    Kidney Int Suppl

    (1998)
  • J. Prakash et al.

    Acute renal failure due to intrinsic renal diseases: review of 1122 cases

    Ren Fail

    (2003)
  • M. Bertolissi

    Prevention of acute renal failure in major vascular surgery

    Minerva Anestesiol

    (1999)
  • C.M. Mangano et al.

    Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. Multicenter Study of Perioperative Ischemia Research Group

    Ann Intern Med

    (1998)
  • J.H. Schaefer et al.

    Outcome prediction of acute renal failure in medical intensive care

    Intensive Care Med

    (1991)
  • B. Schwilk et al.

    Epidemiology of acute renal failure and outcome of haemodiafiltration in intensive care

    Intensive Care Med

    (1997)
  • A. de Mendonca et al.

    Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score

    Intensive Care Med

    (2000)
  • P. Storset et al.

    Organ function during early acute renal failure does not predict survival in long-term intensive care

    Intensive Care Med

    (1995)
  • F. Cosentino et al.

    Risk factors influencing survival in ICU acute renal failure

    Nephrol Dial Transplant

    (1994)
  • C. Guerin et al.

    Initial versus delayed acute renal failure in the intensive care unit. A multicenter prospective epidemiological study. Rhone-Alpes Area Study Group on Acute Renal Failure

    Am J Respir Crit Care Med

    (2000)
  • F.G. Brivet et al.

    Acute renal failure in intensive care units—causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure

    Crit Care Med

    (1996)
  • W.A. Knaus et al.

    APACHE II: a severity of disease classification system

    Crit Care Med

    (1985)
  • M.S. Rangel-Frausto et al.

    The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study

    JAMA

    (1995)
  • C. Brun-Buisson et al.

    EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units

    Intensive Care Med

    (2004)
  • E.A. Hoste et al.

    Acute renal failure in patients with sepsis in a surgical ICU: predictive factors, incidence, comorbidity, and outcome

    J Am Soc Nephrol

    (2003)

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