High risk acute renal failure

Acute renal failure carries a high mortality and little change in survival rate over the last three decades has been seen. Patients requiring intensive care, most of whom have developed acute renal failure following trauma or surgery, have a worse prognosis. The survival in this series of 100 consecutive patients admitted to one intensive care unit between 1976 and 1985 was 35 per cent. The only factors which differed significantly between the surviving and non-surviving patients were age, requirement for mechanical ventilation and maximum serum creatinine level before the first dialysis. It is difficult to predict outcome for an individual patient at the start of treatment and an aggressive approach to management is advocated.