The epidemiology and outcome of acute renal (kidney) failure (ARF) in critically ill patients in different regions of the world have not been well understood, according to background information in the article.
Shigehiko Uchino, M.D., of Austin Hospital, Melbourne, Australia, and colleagues conducted a study to determine the prevalence of ARF in intensive care unit (ICU) patients at 54 hospitals in 23 countries. The ICU patients were either treated with renal replacement therapy (RRT), such as dialysis, or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001.
Of 29,269 critically ill patients admitted during the study period, 1,738 (5.7 percent) had ARF during their ICU stay, including 1,260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5 percent). Approximately 30 percent of patients had preadmission renal dysfunction. The overall hospital death rate was 60.3 percent. Dialysis dependence at hospital discharge was 13.8 percent for survivors. Independent risk factors for hospital death included use of vasopressors (drugs that produce a rise in blood pressure), mechanical ventilation, septic shock, cardiogenic shock, and hepatorenal syndrome (kidney failure combined with severe liver disease).
"In summary, we have conducted a multinational, multicenter, prospective, epidemiological study of ARF that includes the largest and most representative sample of ICUs and ARF patients so far," the authors write. "This information may be helpful in the design of future international interventional trials, which would apply to worldwide practice, in regard to the statistical power and choice of appropriate outcome measures."
(JAMA. 2005; 294:813–818. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by an unrestricted educational grant from the Austin Hospital Anaesthesia and Intensive Care Trust Fund.
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JAMA