End-stage renal failure patients requiring renal replacement therapy in the intensive care unit: incidence, clinical features, and outcome.
OBJECTIVE
To study incidence, clinical features, and outcome of critically ill patients with end-stage renal failure (ESRF) requiring renal replacement therapy (RRT) in the intensive care unit (ICU) and to test the validity of severity scoring systems for these patients.


METHODS
Data for ESRF patients treated with RRT were collected from 81 Australian adult ICUs providing RRT. They were compared with matched controls with acute renal failure.


RESULTS
Thirty-eight ESRF patients received RRT in the ICU over 3 months. The mean APACHE II score was 21.8 (predicted mortality: 37%) and the SAPS II score 44.7 (predicted mortality: 37%). The hospital mortality was 34%. Receiver operating characteristic curves showed good discrimination ability for hospital mortality for these two scores (AUC: 0.81 for APACHE II and 0.84 for SAPS II). Using admission diagnosis and SAPS II scores, 32 ESRF patients treated with continuous RRT (CRRT) were matched to 32 acute renal failure patients also treated with CRRT. ICU mortality (22 vs. 38%) and hospital mortality (38 vs. 38%) were comparable between the two groups.


CONCLUSIONS
ESRF patients requiring RRT in the ICU were relatively frequent. Severity scores could be used to predict the hospital outcome for these patients. Their mortality, when treated with CRRT, was similar to that of diagnosis- and severity-score-matched patients with acute renal failure.
Uchino
Shigehiko
S
Departments of Intensive Care and Medicine, Austin and Repatriation Medical Centre, Melbourne, Australia.
Morimatsu
Hiroshi
H
Bellomo
Rinaldo
R
Silvester
William
W
Cole
Louise
L
D018806:APACHE; D058186:Acute Kidney Injury / Q000453:epidemiology / Q000628:therapy; D016022:Case-Control Studies; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D007902:Length of Stay; D011446:Prospective Studies; D012372:ROC Curve; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology