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Kidney failure a significant cause of ICU deaths worldwide

Results of first large international study of acute renal failure in the ICU published in JAMA

University of Pittsburgh Medical Center

PITTSBURGH, Aug. 16 - In the first multinational study of acute renal failure (ARF) in ICU patients, an international group of researchers has found that a surprisingly high number of intensive care patients - one in 20 - develop a severe form of ARF, and an alarmingly high number of those patients will die in the hospital. The study is published in the August 17 issue of the Journal of the American Medical Association.

Researchers analyzed data from 29,269 critical care patients from 54 medical centers in 23 countries over the span of 15 months. They found that universally almost 6 percent of these patients developed ARF while in the hospital, and of those patients, 60 percent died while hospitalized.

"It's interesting that a person in any hospital, in any country has such a high risk of having kidney failure. An estimated five million Americans will go to the ICU this year, and if this number holds true, 250,000 will go into acute renal failure. Compare this with the 100,000 Americans who will develop chronic renal failure this year and the numbers are staggering," said John Kellum, M.D., corresponding author of the paper, and professor of critical care medicine, University of Pittsburgh School of Medicine. "And this is something we simply did not know, nor could we have predicted. In fact, the numbers are much higher than had been predicted."

The study was undertaken by the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) investigators, an international group of critical care and nephrology experts, to gather baseline information on ARF. Prior to this and other BEST Kidney studies, there was scant epidemiological information on ARF on a global level, which made it difficult for researchers to design clinical trials to determine what interventions would be best for these patients.

"Before we try to develop treatments for ICU patients with acute renal failure, we first need to understand how big the problem is and in whom it arises" said Dr. Kellum. "We have provided a good foundation for understanding with this study."

Additionally, researchers reported that of the surviving patients, 86 percent were not dependent on dialysis after discharge. The BEST Kidney investigators say that this could be an important clue in treating ARF.

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In addition to Dr. Kellum, the BEST Kidney researchers contributing to this publication include: first author, Shigehiko Uchino, M.D., Austin Hospital in Melbourne, Australia; Rinaldo Bellomo, M.D., and Hiroshi Morimatsu, M.D., Austin Hospital; Gordon S. Doig, Ph.D., University of Sydney and Royal North Shore Hospital, Sydney, Australia; Stanislao Morgera, M.D., University Hospital Charité, Berlin; Miet Schetz, M.D., Universitair Ziekenhuis Gasthuisberg, Leuven, Belguim; Ian Tan, M.D., Pamela Youde Nethersole Eastern Hospital, Hong Kong; Catherine Bouman, M.D., Academic Medical Center, Amsterdam, the Netherlands; Ettiene Macedo, M.D., University of São Paulo, Brazil; Noel Gibney, M.D., University of Alberta, Canada; Ashita Tolwani, M.D., University of Alabama Birmingham; and Claudio Ronco, M.D., St. Bortolo Hospital, Vicenza, Italy.

The BEST Kidney Investigators include 98 researchers from 23 countries, including Ramesh Venkataraman, M.D., assistant professor of critical care medicine, who supervised the portion of the study conducted at the University of Pittsburgh Medical Center.

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