Prognosis of acute renal failure in the elderly

Life expectancy is uncertain in the elderly with ARF. In order to determine whether a costly supportive management is worthwhile, we have studied a group of 68 elderly patients (over 65 years of age) admitted to the ICU with ARF. Patients: 47 male; 21 female; 72 +/- 6 years old. Types of ARF include prerenal 24; obstructive 9; intrinsic 35 (acute tubular necrosis 30; glomerulonephritis 4; vascular 1). The mean simplified acute physiology score (SAPS) was 14 +/- 4; 39 patients (57.3%) had more than two underlying diseases; 42 patients (61.7%) were on mechanical ventilation; 40 patients (60%) underwent haemodialysis. The overall survival rate was 36.7%. Among the parameters studied, organic systemic failure index (OSF), diuresis, blood lactate, systolic blood pressure, urea appearance rate (UAR), differed significantly in survivors and deceased. From these results we conclude that the elderly with non-oliguric ARF, normal blood lactate, low catabolic state, and no more than two organ failures have a fair chance of recovering and should therefore be treated aggressively. In other cases, decisions to proceed with intensive supportive measures should be made according to individual characteristics.