Author(s): Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H,
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Abstract CONTEXT: Although acute renal failure (ARF) is believed to be common in the setting of critical illness and is associated with a high risk of death, little is known about its epidemiology and outcome or how these vary in different regions of the world. OBJECTIVES: To determine the period prevalence of ARF in intensive care unit (ICU) patients in multiple countries; to characterize differences in etiology, illness severity, and clinical practice; and to determine the impact of these differences on patient outcomes. DESIGN, SETTING, AND PATIENTS: Prospective observational study of ICU patients who either were treated with renal replacement therapy (RRT) or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001 at 54 hospitals in 23 countries. MAIN OUTCOME MEASURES: Occurrence of ARF, factors contributing to etiology, illness severity, treatment, need for renal support after hospital discharge, and hospital mortality. RESULTS: Of 29 269 critically ill patients admitted during the study period, 1738 (5.7\%; 95\% confidence interval [CI], 5.5\%-6.0\%) had ARF during their ICU stay, including 1260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5\%; 95\% CI, 45.2\%-49.5\%). Approximately 30\% of patients had preadmission renal dysfunction. Overall hospital mortality was 60.3\% (95\% CI, 58.0\%-62.6\%). Dialysis dependence at hospital discharge was 13.8\% (95\% CI, 11.2\%-16.3\%) for survivors. Independent risk factors for hospital mortality included use of vasopressors (odds ratio [OR], 1.95; 95\% CI, 1.50-2.55; P<.001), mechanical ventilation (OR, 2.11; 95\% CI, 1.58-2.82; P<.001), septic shock (OR, 1.36; 95\% CI, 1.03-1.79; P = .03), cardiogenic shock (OR, 1.41; 95\% CI, 1.05-1.90; P = .02), and hepatorenal syndrome (OR, 1.87; 95\% CI, 1.07-3.28; P = .03). CONCLUSION: In this multinational study, the period prevalence of ARF requiring RRT in the ICU was between 5\% and 6\% and was associated with a high hospital mortality rate.
This article was published in JAMA
and referenced in Kidney Disorders and Clinical Practices