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Hemodialysis for acute renal failure in patients with hematologic malignancies
J J Lanore1, F Brunet, F Pochard
1Medical Intensive Care Unit, Cochin-Port Royal University Hospital, Paris, France.
Objective:
To assess the prognosis of patients with hematologic malignancies in acute renal failure who require hemodialysis.
Design:
Retrospective study.
Setting:
ICU.
Patients:
Forty-three consecutive patients.
Methods:
Prognostic analysis using both univariate and multivariate (stepwise regression) methods.
Results:
Fifteen (35%) patients recovered from acute renal failure and 12 (28%) were discharged from the ICU. The prognosis of patients with acute renal failure linked to sepsis is poorer than the prognosis of the patients with acute renal failure from other etiologies. Only one patient survived in the former group (n = 26) and 11 in the latter group (n = 17); p less than .0001 in multivariate analysis. When accompanied by associated respiratory failure, mortality rate was higher (93% vs. 33%; p less than .0001). The Simplified Acute Physiology Score (SAPS) calculated within the first 24 hr of admission was significantly (p less than .001) related to mortality when the SAPS was greater than or equal to 13. The presence of neutropenia and the type of hematologic malignancy were not related to a worse prognosis. Tolerance to hemodialysis appeared good, and complications were rare.