Acute renal failure in critically ill patients - A multinational, multicenter study

Context Although acute renal failure (ARF) is believed to be common in the setting of critical illness and is associated with a high risk of death, little is known about its epidemiology and outcome or how these vary in different regions of the world. Objectives To determine the period prevalence of ARF in intensive care unit (ICU) patients in multiple countries; to characterize differences in etiology illness severity, and clinical practice; and to determine the impact of these differences on patient outcomes. Design, Setting, and Patients Prospective observational study of ICU patients who either were treated with renal replacement therapy (RRT) or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001 at 54 hospitals in 23 countries. Main Outcome Measures Occurrence of ARF, factors contributing to etiology, illness severity, treatment, need for renal support after hospital discharge, and hospital mortality. Results Of 29 269 critically ill patients admitted during the study period, 1738 (5.7%; 95% confidence interval [CI], 5.5%-6.0%) had ARF during their ICU stay, including 1260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5%; 95% Cl, 45.2%-49.5%). Approximately 30% of patients had preadmission renal dysfunction. Overall hospital mortality was 60.3% (95% Cl, 58.0%-62.6%). Dialysis dependence at hospital discharge was 13.8% (95% Cl, 11.2%-16.3%) for survivors. Independent risk factors for hospital mortality included use of vasopressors (odds ratio [OR], 1.95; 95% Cl, 1.50-2.55; P<.001), mechanical ventilation (OR, 2.11; 95% Cl, 1.58-2.82; P<.001), septic shock (OR, 1.36; 95% Cl, 1.03-1.79; P=.03), cardiogenic shock (OR, 1.41; 95% Cl, 1.05-1.90; P=.02), and hepatorenal syndrome (OR, 1.87; 95% Cl, 1.07-3.28; P=.03). Conclusion In this multinational study; the period prevalence of ARF requiring RRT in the ICU was between 5% and 6% and was associated with a high hospital mortality rate.