Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-22T06:21:52.593Z Has data issue: false hasContentIssue false
  • English
  • Français

Influence of underlying disease on the outcome of critically ill patients with acute renal failure

Published online by Cambridge University Press:  28 January 2005

T. H. Schroeder ,
M. Hansen ,
K. Dinkelaker ,
W. A. Krueger ,
B. Nohé ,
R. Fretschner  and
K. Unertl
T. H. Schroeder
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Critical Care Medicine, Tuebingen, Germany
M. Hansen
Affiliation:
Robert-Bosch-Hospital, Department of Anaesthesiology, Stuttgart, Germany
K. Dinkelaker
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Critical Care Medicine, Tuebingen, Germany
W. A. Krueger
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Critical Care Medicine, Tuebingen, Germany
B. Nohé
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Critical Care Medicine, Tuebingen, Germany
R. Fretschner
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Critical Care Medicine, Tuebingen, Germany
K. Unertl
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Critical Care Medicine, Tuebingen, Germany
Get access

Abstract

Summary

Background and objective: The development of acute renal failure (ARF) in critically ill patients is associated with an increase in hospital mortality. Recently, it was shown that starting renal replacement therapy early and using high-filtrate flow rates can improve the outcome, but this could not be confirmed in later investigations. Studying selected patient subgroups could provide a useful basis for patient selection in future trials evaluating the outcome of renal replacement therapies. We, therefore, investigated the impact of the underlying disease on the outcome of patients with ARF.

Methods: We retrospectively analysed 306 patients with ARF who were treated with renal replacement therapy. Patients were classified according to six initial diagnosis groups: haemorrhagic shock, post-cardiac surgery, post-liver transplantation, trauma, severe sepsis and miscellaneous. Univariate and multivariate multiple logistic regression analysis was used to determine which factors influenced the outcome.

Results: Underlying disease proved to be the only independent risk factor for mortality that was present at intensive care unit (ICU) admission (P = 0.047). Patients with severe sepsis had a significantly higher mortality rate (68%) than ARF patients as a whole (51%) (P = 0.02). Length of stay in the ICU, the use of catecholamines, the delay before ARF onset, and the correlation between APACHE II score and ICU length of stay proved to be additional independent predictors of outcome.

Conclusions: Patient selection and subgroup definition according to the underlying disease could augment the usefulness of future trials evaluating the outcome of ARF.

Keywords

KIDNEY FAILURE, ACUTERENAL REPLACEMENT THERAPYINTENSIVE CAREOUTCOME ASSESSMENT
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 11 , November 2004 , pp. 848 - 853
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Brivet FG, Kleinknecht DJ, Loirat P, Landais PJM, the French study group on acute renal failure. Acute renal failure in intensive care units – causes, outcome, and prognosis factors of hospital mortality: a prospective, multicenter study. Crit Care Med 1996; 24: 192–198.Google Scholar
Guérin C, Girard R, Selli J, Perdrix J, Ayzac L, the Rhone–Alpes Area study group on acute renal failure. Initial versus delayed acute renal failure in the intensive care unit. Am J Respir Crit Care Med 2000; 161: 872–879.Google Scholar
Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus M. Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med 1995; 155: 1505–1511.Google Scholar
Liano F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid acute renal failure study group. Kidney Int 1998; 66: S16–S24.Google Scholar
Kresse S, Schlee H, Deuber HJ, Koall W, Osten B. Influence of renal replacement therapy on outcome of patients with acute renal failure. Kidney Int 1999; 56: S75–S78.Google Scholar
Druml W. Prognosis of acute renal failure. 1975–1995. Nephron 1996; 73: 8–15.Google Scholar
Silvester W, Bellomo R, Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med 2001; 29: 1910–1915.Google Scholar
Cosentino F, Chaff C, Piedmonte M. Risk factors influencing survival in ICU acute renal failure. Nephrol Dial Transplant 1994; 9: 179–182.Google Scholar
Gettings LG, Reynolds HN, Scalea T. Outcome in post-traumatic acute renal failure when continuous renal replacement therapy is applied early vs. late. Intensive Care Med 1999; 25: 805–813.Google Scholar
Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000; 355: 26–30.Google Scholar
Bouman CS, Oudemans-van Straaten HM, Tijssen JG, Zandstra DF, Kesecioglu J. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med 2002; 30: 2205–2211.Google Scholar
Kellum JA, Metha RL, Angus DC, Palevsky P, Ronco C for the ADQI workgroup. The first international consensus conference on continuous renal replacement therapy. Kidney Int 2002; 62: 1855–1863.Google Scholar
Tonelli M, Manns B, Feller-Kopman D. 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 2002; 40: 875–885.Google Scholar
Metnitz PGH, Krenn CG, Steitzer H, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in criticall ill patients. Crit Care Med 2002; 30: 2051–2058.Google Scholar
Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998; 104: 343–348.Google Scholar
Bent P, Tan HK, Bellomo R, et al. Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. Ann Thorac Surg 2001; 71: 832–837.Google Scholar
Lins RL, Elseviers M, Daelemans R, et al. Prognostic value of a new scoring system for hospital mortality in acute renal failure. Clin Nephrol 2000; 53: 10–17.Google Scholar
Lins RL, Elseviers M, Daelemans R, De Broe ME. Problems in the development, validation, and adaptation of prognostic models for acute renal failure. Nephrol Dial Transplant 2001; 16: 1098–1101.Google Scholar
Chen Y, Hsu H, Kao K, Fang J, Huang C. Outcomes and APACHE II predictions for critically ill patients with acute renal failure requiring dialysis. Ren Fail 2001; 23: 61–70.Google Scholar
Krueger WA, Lenhart FP, Neeser G, et al. Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 2002; 166: 1029–1037.Google Scholar
Gonwa TA, Mai MLM, Melton LB, et al. Renal replacement therapy and orthotopic liver transplantation: the role of continuous veno-venous hemodialysis. Transplantation 2001; 71: 1424–1428.Google Scholar
Metha RL, McDonald B, Gabbai FB, et al. A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 2001; 60: 1154–1163.Google Scholar
Platz KP, Mueller AR, Blumhardt G, et al. Nephrotoxicity after orthotopic liver transplantation in cyclosporin A and F 506 treated patients. Transpl Int 1994; 7: S52–S57.Google Scholar
Rasmussen HH, Pitt EA, Ibels LS, McNeil DR. Prediction of outcome in acute renal failure by discriminant analysis of clinical variables. Arch Intern Med 1985; 145: 2015–2018.Google Scholar
Conlon PJ, Stafford-Smith M, White WD, et al. Acute renal failure following cardiac surgery. Nephrol Dial Transplant 1999; 14: 1158–1162.Google Scholar
Metnitz PGH, Krenn CG, Steltzer H, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 2002; 30: 2051–2058.Google Scholar
Hoste EA, Lameire NH, Vanholder RC, Benoit DD, Decruyenaere JM, Colardyn FA. Acute renal failure in patients with sepsis in a surgical ICU: predictive factors, incidence, comorbidity, and outcome. J Am Soc Nephrol 2003; 14: 1022–1030.Google Scholar