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Acute renal failure in critically ill patients: a multinational, multicenter study.

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Epidemiology

Background:

  • Acute renal failure (ARF) is a significant concern in critical illness, yet its global epidemiology and outcomes remain poorly understood.
  • Existing knowledge gaps highlight the need for comprehensive international data on ARF prevalence and associated mortality.

Purpose of the Study:

  • To determine the period prevalence of ARF in intensive care unit (ICU) patients across multiple countries.
  • To analyze variations in ARF etiology, illness severity, and clinical practices globally.
  • To assess the impact of these diverse factors on patient outcomes and mortality.

Main Methods:

  • A prospective, multinational observational study involving 54 hospitals in 23 countries.
  • Data collected from September 2000 to December 2001 on ICU patients meeting ARF criteria or receiving renal replacement therapy (RRT).
  • Key outcome measures included ARF occurrence, etiology, severity, treatment, post-discharge renal support, and hospital mortality.

Main Results:

  • The period prevalence of ARF in ICU patients was 5.7%, with 1260 patients requiring RRT.
  • Septic shock was the most frequent cause of ARF (47.5%), and 30% of patients had pre-existing renal dysfunction.
  • Overall hospital mortality was 60.3%, with dialysis dependence at discharge for 13.8% of survivors. Independent mortality predictors included vasopressor use, mechanical ventilation, septic shock, cardiogenic shock, and hepatorenal syndrome.

Conclusions:

  • The study confirms a 5-6% period prevalence of ARF requiring RRT in ICUs worldwide.
  • ARF in critically ill patients is associated with a substantial hospital mortality rate.
  • Multifactorial risk factors significantly influence mortality in ICU patients with ARF.