IMPROVEMENT IN PROGNOSIS OF PATIENTS WITH ACUTE-RENAL-FAILURE OVER A PERIOD OF 15 YEARS - AN ANALYSIS OF 710 CASES IN A DIALYSIS CENTER

In order to evaluate the changes in causes and outcome of acute renal failure (ARF) during the years 1975-1989, 710 patients treated in our dialysis center were analyzed. We compared the etiology, the severity and catabolic state of ARF, the techniques of renal replacement therapy, which were employed and the ages and mortality rates of these patients, who received dialysis therapy during the years 1975-79 (n = 227), 1980-84 (n = 240) and 1985-89 (n = 243). The number of postoperative, posttraumatic and non-traumatic cases of ARF was approximately the same in all three 5-year periods, only the frequency of postrenal failure decreased from 7% in the years 1975-79 to 3% in the years 1985-89. The incidence of sepsis as a major cause of ARF and the most important risk factor was comparably high in the surgical and medical patients during all of the periods, but it increased in the traumatic patients from 7% in the years 1975-79 to 28% during the last 5-year period. The prevalence of respiratory failure and jaundice as additional organ failures, the severity of ARF (oligonanuric-nonoliguric) and the metabolic state were not different in the three patient groups. The magnitude of rise in serum creatinine before the start of renal replacement therapy was significant lower in the last 5-year period in comparison to the years 1975-79 (p < 0.05). Hemodialysis was the treatment in choice of 98 and 93% of the cases during the first two periods, respectively. Since 1980, bicarbonate was employed in the dialysis instead of acetate in the most cases. In the years 1985-89, hemodialysis was only performed in 51% of the patients, intermittent or continuous hemofiltration was used in 49%. The mortality of all the patients was reduced from 69% in the years 1975-79 to 54 and 48%, respectively, in the last two 5-year periods (p < 0.01), though the mean age of the patients has increased from 44 (9-84) to 57 (10-84) and 58 years (15-90), respectively. This improvement in outcome has been demonstrated in surgical and traumatic as well as nontraumatic and postrenal failure.