Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study.
BACKGROUND
Severe acute renal failure (sARF) is associated with considerable morbidity, mortality and use of healthcare resources; however, its precise epidemiology and long-term outcomes have not been well described in a non-specified population.


METHODS
Population-based surveillance was conducted among all adult residents of the Calgary Health Region (population 1 million) admitted to multidisciplinary and cardiovascular surgical intensive care units between May 1 1999 and April 30 2002. Clinical records were reviewed and outcome at 1 year was assessed.


RESULTS
sARF occurred in 240 patients (11.0 per 100,000 population/year). Rates were highest in males and older patients (> or = 65 years of age). Risk factors for development of sARF included previous heart disease, stroke, pulmonary disease, diabetes mellitus, cancer, connective tissue disease, chronic renal dysfunction, and alcoholism. The annual mortality rate was 7.3 per 100,000 population with rates highest in males and those > or = 65 years. The 28-day, 90-day, and 1-year case-fatality rates were 51%, 60%, and 64%, respectively. Increased Charlson co-morbidity index, presence of liver disease, higher APACHE II score, septic shock, and need for continuous renal replacement therapy were independently associated with death at 1 year. Renal recovery occurred in 78% (68/87) of survivors at 1 year.


CONCLUSIONS
sARF is common and males, older patients, and those with underlying medical conditions are at greatest risk. Although the majority of patients with sARF will die, most survivors will become independent from renal replacement therapy within a year.
Bagshaw
Sean M
SM
Department of Critical Care Medicine, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada. smbagsha@ucalgary.ca
Laupland
Kevin B
KB
Doig
Christopher J
CJ
Mortis
Garth
G
Fick
Gordon H
GH
Mucenski
Melissa
M
Godinez-Luna
Tomas
T
Svenson
Lawrence W
LW
Rosenal
Tom
T
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D017677:Age Distribution; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D011379:Prognosis; D020127:Recovery of Function; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis