Identification of factors causing acute renal failure (ARF) and its associated poor prognosis in critically ill patients can help in planning strategies to prevent ARF and to prioritize the utilization of sparse and expensive therapeutic modalities. Most of the studies in such patients have been done in the developed world, and similar data from the developing world is sparse. We analyzed 45 consecutive patients who developed ARF in the intensive care unit (ICU) during a 12-month period. Demographic and detailed biochemical profile, previous chronic illness, precipitating factors, number of failed organs, type of ARF (oliguric/nonoliguric), and need for and type of renal replacement therapy (RRT) received were recorded at the time of admission to ICU and during the course of illness. The mean age of these patients was 43.1 years, with 75.6% being males. Hypotension, sepsis, and use of nephrotoxic drugs were common precipitating factors for ARF in these patients. However, multiple precipitating factors were present in the majority (80%): 81.5% had at least one organ failure prior to development of ARF, 71.1% had oliguria, and 71.1% required RRT. Intermittent hemodialysis was the most common form of RRT given. Patient mortality was 64.4%, with 15 of the 16 surviving patients becoming dialysis independent. We observed an increase in mortality from 0% to 100%, depending on the number of failed organs from one to six. On comparing the predictor outcomes between survivors and nonsurvivors by multivariate analysis, only the number of failed organs at the time of ARF (2.6 +/- 0.9 vs. 4.5 +/- 0.8) and serum albumin < 3.0 g/dL were found to be statistically significant. To conclude, ARF in critically ill patients is multifactorial in origin and carries a high mortality. Mortality in these patients increases with increasing numbers of failed organs and with a serum albumin of < 3.0 g/dL.
Early TPE help to remove plasma protein bound toxin with significant mortality reduction. However, delay in start of TPE after ingestion of poison has significant poor survival outcome.
Background: The majority of the patients with chronic kidney disease stage V on hemodialysis have been found to have hypertension and many studies have recommended that hypertension should be essentially controlled in these patients for better clinical outcome. But till now no study analyzing the relationship between antihypertensive medication and the demographics of the patient has been done, so with this objective in mind the present study was carried out. Aim and objectives were to analyse the types of antihypertensive being used in CKD stage V patients on hemodialysis and their relationship with the demographic variables.Methods: The present observational cross-sectional study was conducted in Sri Aurobindo Institute of Medical Sciences, Indore (M.P.) from 01 January 2018 to 31 March 2018 on patients with chronic kidney disease stage V on hemodialysis. The demographic variables evaluated were age, sex, basic disease and duration of dialysis. The relationship with type of antihypertensive being used and these demographic variables was calculated using Pearson Chi-square test. A p value of<0.05 was taken as statistically significant.Results: Diabetic nephropathy, CIN-CKD 5d, CGN-CKD 5d and hypertensive nephropathy were the commonest basic diseases in our study. Calcium channel blockers, beta blockers, ATRB, centrally acting antihypertensive, ACE inhibitors were the commonest antihypertensive used. Statistically significant relationship was seen between antihypertensive and basic disease (p<0.05).Conclusions: The study revealed that all the antihypertensive medications are prescribed on the basis of basic disease while other demographic variables do not play a vital role prescribing antihypertensive in patients with CKD stage V on haemodialysis. And the prescription of antihypertensive medications also matches with the actual clinical practice.
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