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Intensive Care Medicine

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01-02-2005 | Original

Prognosis of acute renal failure: an evaluation of proposed consensus criteria

Authors: M. E. Ostermann, R. W. S. Chang, for the Riyadh ICU Program Users Group

Published in: Intensive Care Medicine | Issue 2/2005

Abstract

Objectives

To validate the recently proposed criteria for acute renal injury (ARI), acute renal failure syndrome (ARFS) and severe acute renal failure syndrome (SARFS) and to evaluate the significance of other prognostic factors.

Design and setting

Retrospective analysis of the Riyadh ICU Program database of patients admitted to 22 ICUs in UK and Germany between 1989 and 1998.

Patients

Included in the study were 41,972 patients, of whom 7,522 (17.9%) had ARI, 2,641 (6.3%) had ARFS and 1,747 (4.2%) had SARFS.

Results

Patients with ARI, ARFS or SARFS had a hospital mortality of 29.5%, 49.2% or 63.0%, respectively, compared to 10.3% among patients without acute renal failure. In the presence of contemporaneous failure of any other organs on the day of acute renal failure, hospital mortality increased to 73.3%, 76.2%, 72.1% and 18%, respectively. Multivariate analysis showed that non-surgical admission, need for emergency surgery, development of acute renal failure during stay in ICU, need for mechanical ventilation and the number of other failed organ systems had a greater impact on prognosis than the need for renal replacement therapy.

Conclusions

The proposed criteria for ARI, ARFS and SARFS correlated with mortality, but other factors had a greater impact on prognosis. Renal replacement therapy did not increase the risk of hospital mortality among patients with acute renal failure.

Nair P, Bihari D (1997) Acute renal failure in the ICU in the 1990 s—”anything goes”? Intensive Care Med 23:1193–1196

Cosentino F, Chaff C, Piedmonte M (1994) Risk factors influencing survival in ICU acute renal failure. Nephrol Dial Transplant 9 (Suppl 4):179–182

Kellum JA, Angus DC (2002) Patients are dying of acute renal failure. Crit Care Med 30:2156–2157

Breen D, Bihari D (1998) Acute renal failure as a part of multiple organ failure: the slippery slope of critical illness. Kidney Int 53 (Suppl 66):S25–S33

Novis BK, Roizen MF, Aronson S, Thisted RA (1994) Association of preoperative risk factors with postoperative acute renal failure. Anesth Analg 78:143–149PubMed

Bellomo R, Kellum J, Ronco C (2001) Acute renal failure: time for consensus. Intensive Care Med 27:1685–1688

Knaus WA, Draper EA, Wagner DP, Zimmermann JE (1985) Prognosis in acute organ-system failure. Ann Surg 202:685–693PubMed

Chang RWS, Jacobs S, Lee B (1987) Gastrointestinal dysfunction among intensive care unit patients. Crit Care Med 15:909–914PubMed

Knaus WA, Draper EA, Wagner DP, Zimmermann JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed

10.

Neveu H, Kleinknecht D, Brivet F, Loirat P, Landais P and The French Study Group on Acute Renal Failure (1996) Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. Nephrol Dial Transplant 11:293–299

11.

Brivet FG, Kleinknecht DJ, Loirat P, Landais PJM, The French Study Group on Acute Renal Failure (1996) Acute renal failure in intensive care units—causes, outcome and prognostic factors of hospital mortality: a prospective, multicenter study. Crit Care Med 24:192–198CrossRefPubMed

12.

Liano F, Junco E, Pascual J, Madero R, Verde E, and the Madrid Acute Renal Failure Study Group (1998) The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. Kidney Int 53:S16–S24

13.

Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus M (1995) Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med 155:1505–1511CrossRefPubMed

14.

Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, Paganini EP, Chertow GM, for the Program to Improve Care in Acute Renal Disease (PICARD) (2004) Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int 66(4):1613–1621CrossRefPubMed

15.

Groeneveld ABJ, Tran DD, Van der Meulen J, Nauta JJP, Thijs LG (1991) Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome. Nephron 59:602–610PubMed

16.

Vivino G, Antonelli M, Moro ML, Cottini F, Conti G, Bufi M, Cannata F, Gasparetto A (1998) Risk factors for acute renal failure in trauma patients. Intensive Care Med 24:808–814

17.

Metnitz PGH, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058

18.

Druml W (1996) Prognosis of acute renal failure 1975–1995. Nephron 73:8–15PubMed

19.

Bernieh B, Al Hakim M, Boobes Y, Siemkovics E, El Jack H (2004) Outcome and predictive factors of acute renal failure in the intensive care unit. Transplant Proc 36(6):1748–1747

20.

Levy EM, Viscoli CM, Horwitz RI (1996) The effect of acute renal failure on mortality—a cohort analysis. JAMA 275:1489–1494CrossRefPubMed

21.

Druml W (1999) Metabolic aspects of continuous renal replacement therapies. Kidney Int 56 (Suppl 72): S56–S61

22.

Schetz M (1999) Non-renal indications for continuous renal replacement therapy. Kidney Int 56 (Suppl 72): S88–S94

23.

Kellum JA, Angus DC, Johnson JP, Leblanc M, Griffin M, Ramakrishnan N, Linde-Zwirble WT (2002) Continuous versus intermittent renal replacement therapy: a meta-analysis. Intensive Care Med 28:29–37

24.

Tonelli M, Manns B, Feller-Kopman D (2002) Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery. Am J Kidney Dis 40:875–885CrossRefPubMed

Title: Prognosis of acute renal failure: an evaluation of proposed consensus criteria
Authors: M. E. Ostermann
R. W. S. Chang
for the Riyadh ICU Program Users Group
Publication date: 01-02-2005
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2523-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognosis of acute renal failure: an evaluation of proposed consensus criteria

Abstract

Objectives

Design and setting

Patients

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Design and setting

Patients

Results

Conclusions

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