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Acute renal failure in the intensive care unit
J Prakash1, A S Murthy, R Vohra
1Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
The Journal of the Association of Physicians of India
|January 12, 2007
Summary
Acute renal failure (ARF) in the intensive care unit (ICU) affects nearly 4% of patients and is linked to high mortality. Sepsis and multiple organ system failure significantly worsen outcomes for ICU patients with ARF.
Area of Science:
- Nephrology
- Critical Care Medicine
- Internal Medicine
Background:
- Acute renal failure (ARF) in the intensive care unit (ICU) presents a significant challenge with high mortality rates.
- A comprehensive understanding of ARF's clinical spectrum is crucial for developing effective interventions.
Purpose of the Study:
- To investigate the clinical spectrum, causes, and risk factors of ARF in ICU patients.
- To identify prognostic factors and analyze the final outcomes of ARF within the ICU setting.
Main Methods:
- A prospective study of 1215 ICU admissions over 17 months, including 46 patients who developed ARF.
- Collected clinical and laboratory data, APACHE-III scores, and patient characteristics for survival analysis.
- Utilized univariate and multivariate analyses to predict survival and identify prognostic factors.
Main Results:
- ARF developed in 3.79% of ICU patients, with a mean age of 44.9 years; 56.5% were male.
- Common comorbidities included hypertension, diabetes mellitus, and coronary artery disease. Etiologies of ARF were multifactorial, including hypotension, volume depletion, nephrotoxic drugs, and sepsis.
- Mortality was high at 63%, with multiple organ system failure (MOSF) and sepsis identified as significant adverse prognostic factors.
Conclusions:
- ARF occurred in 3.79% of ICU cases and was associated with a poor prognosis.
- Sepsis, MOSF, elevated APACHE-III scores, and the need for ventilation were correlated with increased mortality in ICU patients with ARF.
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