Acute renal failure requiring renal replacement therapy: incidence and outcome.
BACKGROUND
Renal replacement therapy (RRT) for acute renal failure (ARF) may be provided in many settings within the hospital. Such patients require a high level of care and often have a poor prognosis. No prospective studies have accurately defined this population, making the prediction of necessary resources and the planning of services difficult.


OBJECTIVE
To ascertain the incidence, causes and outcomes of acute renal failure requiring renal replacement therapy in Scotland.


METHODS
A prospective observational census of all clinical areas providing renal replacement therapy in three Scottish health boards (Grampian, Highland, Tayside).


METHODS
Patients were identified by liaison with each unit providing RRT. Factors precipitating renal failure and reasons for RRT were recorded at the time of initiation. Comorbid disease burden was scored using the Charlson index. Patient status at 90 days was assessed from case-notes, contacting general practitioners where necessary.


RESULTS
375 patients per million population per year received RRT; 203 per million per year for either ARF or acute-on-chronic renal failure. 73.5% of patients receiving RRT for ARF died within 90 days, 23.5% became independent of RRT. The median duration of hospital admission was 19 days.


CONCLUSIONS
The annual incidence of ARF requiring RRT is just over 200 per million population, almost twice that of end-stage renal disease requiring RRT. Such treatment places high demands upon health care resources.
Metcalfe
W
W
Department of Medicine and Therapeutics, University of Aberdeen, Glasgow Royal Infirmary, Glasgow, UK. MetcalfeWendy@aol.com
Simpson
M
M
Khan
I H
IH
Prescott
G J
GJ
Simpson
K
K
Smith
W C S
WC
MacLeod
A M
AM
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome