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The evolution of acute renal failure, 1956-1988.

J H Turney1, D H Marshall, A M Brownjohn

  • 1General Infirmary, Leeds.

The Quarterly Journal of Medicine
|January 1, 1990
PubMed
Summary

Despite an aging patient population and complex conditions, survival rates for severe acute renal failure (ARF) improved significantly between 1956 and 1988. Advances in treatment enhanced prognosis for ARF, particularly intrinsic renal disease.

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Area of Science:

  • Nephrology
  • Internal Medicine
  • Critical Care Medicine

Background:

  • Severe acute renal failure (ARF) presents significant challenges in patient management.
  • Historical data on ARF outcomes are crucial for understanding treatment evolution.
  • Patient demographics and disease profiles in ARF have evolved over time.

Purpose of the Study:

  • To analyze trends in patient demographics, case-mix, and survival rates for severe acute renal failure.
  • To evaluate the impact of changing patient profiles on ARF outcomes.
  • To assess improvements in ARF prognosis over a 30-year period.

Main Methods:

  • Retrospective review of 1347 patients with severe ARF treated between 1956 and 1988.
  • Inclusion criteria: acute uremic episode requiring dialysis and/or serum creatinine > 600 μmol/l.

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  • Analysis of patient age, case-mix, complicating factors, and survival rates over different time periods.

    • Main Results:

    • Patient age increased significantly, with a shift towards elderly patients and complex medical/surgical conditions.
    • Survival rates for ARF progressively improved from 48.8% (1956-1959) to 57.9% (1985-1988).
    • Improved survival was observed for medical and surgical cases, with better prognosis for ARF in general and intrinsic renal disease.

    Conclusions:

    • Despite an aging population and increased disease complexity, overall survival in severe ARF has improved.
    • Advances in the management of acute renal failure have led to better patient outcomes.
    • The study highlights the importance of continuous improvement in critical care for severe renal failure patients.