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Identifying critically ill patients at high risk for developing acute renal failure: a pilot study
Lakhmir S Chawla1, Lynn Abell, Ramin Mazhari
1Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University Medical Center, Washington, DC 20037, USA. lchawla@mfa.gwu.edu
Kidney International
|October 14, 2005
Summary
Predicting acute renal failure (ARF) in critically ill patients is challenging. Key predictors for ARF in intensive care unit (ICU) patients include low serum albumin, elevated A-a gradient, and active cancer.
Area of Science:
- Nephrology
- Critical Care Medicine
- Internal Medicine
Background:
- Acute renal failure (ARF) is a common complication in intensive care units (ICUs).
- Predicting ARF development in critically ill patients admitted without ARF is challenging.
- Identifying predictive risk factors for ARF is crucial for timely intervention.
Purpose of the Study:
- To identify specific risk factors that predict the development of ARF in critically ill patients admitted to the ICU.
- To establish a predictive model for ARF in a medical-surgical ICU population.
Main Methods:
- A cohort of 194 medical-surgical ICU admissions was enrolled between August 2002 and April 2003.
- A sampling tool based on categorized risk factors (chronic major, chronic minor, acute) was utilized.
- Patients with end-stage renal disease or ARF upon admission were excluded.
Main Results:
- Univariate analysis identified increased APACHE II quartile, elevated A-a gradient, systemic inflammatory response syndrome (SIRS), decreased serum albumin, and active cancer as predictors of ARF.
- Logistic regression revealed decreased serum albumin (protective effect), increased A-a gradient, and active cancer as significant predictors (OR 2.17, 1.04, 2.86, respectively).
Conclusions:
- Decreased serum albumin concentration, increased A-a gradient, and the presence of active cancer are significant predictors of ARF in ICU patients.
- These factors can aid in identifying critically ill patients at higher risk for developing ARF.