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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
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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

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