Epidemiology of severe acute renal failure and prognosis for renal recovery in critically ill patients.

摘要

Severe acute renal failure (sARF) in the critically ill requiring dialysis is associated with considerable morbidity, mortality and health care costs. The current objective of this study was to describe the epidemiology of sARF and factors influencing long-term mortality and prognosis for renal recovery. This was a population-based surveillance cohort study. Adult residents of the Calgary Health Region (population 1 million) admitted to any multidisciplinary intensive care unit (ICU) and a cardiovascular surgery ICU from May 1, 1999 to April 30, 2002 were eligible for inclusion. Severe acute renal failure was diagnosed in 240 patients for an annual incidence of 11.0 (Exact 95% CI 9.6--12.5) per 100,000 population. Renal recovery occurred in 78% (68/87) of survivors at 1-year after a median duration of renal replacement therapy of 11 days. By stratified analysis, renal recovery was associated with the several factors including: male sex, age 65 years, lower Charlson co-morbidity index score, an intra-renal etiology of sARF, a diagnosis of septic shock and use of continuous renal replacement therapy as the modality of renal replacement. In conclusion, the occurrence of sARF was common enough, to be clinical important. Those at greatest risk for sARF are males, older patients, and those with pre-existing co-morbidities. Although the majority of patients with sARF will die, most survivors will become independent from renal replacement therapy within a year. (Abstract shortened by UMI.)