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Related Experiment Videos

Multi-organ renal failure in the elderly.

G H Neild1

  • 1Middlesex Hospital, London, UK. g.neild@ucl.ac.uk

International Urology and Nephrology
|May 7, 2002
PubMed
Summary

Despite decades of research, acute renal failure (ARF) mortality remains high, particularly in sepsis and elderly patients. Recent advances in ventilation and glucocorticoid therapy may offer future improvements in patient outcomes.

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Internal Medicine

Background:

  • High mortality rates in acute renal failure (ARF) have persisted despite advances in medical care.
  • Historically, patient populations treated for ARF have included older and sicker individuals, with little improvement in survival rates observed between 1960 and 1985.
  • Current literature suggests a stable patient demographic and case mix over the past decade, yet outcomes remain poor.

Purpose of the Study:

  • To examine the persistent challenges and historical trends in acute renal failure (ARF) mortality.
  • To identify specific patient groups with particularly poor prognoses, such as those with sepsis or elderly patients with multi-organ failure.
  • To review recent therapeutic advancements that may impact ARF outcomes.

Main Methods:

  • Literature review of studies published over the past decade and historical data from 1960-1985.
  • Analysis of patient demographics, case mix, and survival rates in acute renal failure.
  • Evaluation of treatment modalities and their impact on patient outcomes in intensive care units.

Main Results:

  • Mortality in ARF remains high, with survival rates around 50% for patients with oliguria resistant to initial treatments.
  • Patients with ARF complicated by sepsis face mortality rates of 65-80%.
  • Elderly patients with failure of two or more organs experience particularly poor outcomes.

Conclusions:

  • Progress in improving ARF outcomes has been slow, with limited changes in intensive care unit (ICU) management over the past 20 years, primarily shifting from parenteral to enteral nutrition.
  • Specific patient subgroups, including those with sepsis and the elderly with multi-organ failure, continue to have dismal prognoses.
  • Emerging strategies, such as advanced ventilatory techniques and high-dose glucocorticoid therapy, show potential for improving future ARF outcomes.

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