Incidence, risk factors and prognostic factors of acute renal failure in patients admitted to an intensive care unit

Abstract

The objective of the present study was to assess the incidence, risk factors and outcome of patients who develop acute renal failure (ARF) in intensive care units. In this prospective observational study, 221 patients with a 48-h minimum stay, 18-year-old minimum age and absence of overt acute or chronic renal failure were included. Exclusion criteria were organ donors and renal transplantation patients. ARF was defined as a creatinine level above 1.5 mg/dL. Statistics were performed using Pearsons' χ 2 test, Student t-test, and Wilcoxon test. Multivariate analysis was run using all variables with P < 0.1 in the univariate analysis. ARF developed in 19.0% of the patients, with 76.19% resulting in death. Main risk factors (univariate analysis) were: higher intra-operative hydration and bleeding, higher death risk by APACHE II score, logist organ dysfunction system on the first day, mechanical ventilation, shock due to systemic inflammatory response syndrome (SIRS)/sepsis, noradrenaline use, and plasma creatinine and urea levels on admission. Heart rate on admission (OR = 1.023 (1.002-1.044)), male gender (OR = 4.275 (1.340-13642)), shock due to SIRS/sepsis (OR = 8.590 (2.710-27.229)), higher intra-operative hydration (OR = 1.002 (1.000-1004)), and plasma urea on admission (OR = 1.012 (0.980-1044)) remained significant (multivariate analysis). The mortality risk factors (univariate analysis) were shock due to SIRS/sepsis, mechanical ventilation, blood stream infection, potassium and bicarbonate levels. Only potassium levels remained significant (P = 0.037). In conclusion, ARF has a high incidence, morbidity and mortality when it occurs in intensive care unit. There is a very close association with hemodynamic status and multiple organ dysfunction.

Study of causes and prognosis of acute kidney injury (AKI) in tertiary care institute

“…This is with Mataloun et al mean age is 55.3 years and In Picard study it is 59.5 years. 13,14 In Ibrahim A et al study mean age is 36.7±14.5 years. Clinical features are comparable with other studies particularly in relation to fever and oliguria.…”

Injúria Renal Aguda: Estudo De 179 Casos Internados No Hospital De Clínicas Da Universidade Federal Do Paraná (Ufpr)

“…Os pacientes podem desenvolver a IRA na comunidade ou, mais frequentemente, em ambientes hospitalares, geralmente em consequência de septicemia, exposição a contrastes iodados, cirurgias, traumatismos ou hemorragias [3][4][5][6][7][8][9][10] . A incidência de IRA no paciente hospitalizado varia entre 5% e 60%, sendo que 5 a 30% desses pacientes apresentam necessidade de terapia de substituição Renal (TSR) 1,2 .…”

Eventos vitais estressores e lesão renal aguda em centros de terapia semi-intensiva e intensiva

“…Studies related to the incidence and mortality rates of AKI in an intensive care unit (ICU) show very high rates. [1][2][3] Many conditions are associated with AKI, such as cardiocirculatory surgeries, polytraumatism, septicemia, use of contrast, bleeding, among others. [3][4][5][6] The high mortality rate of these pathologies, especially in ICU, brings out the need for attention for this disease.…”

“…[1][2][3] Many conditions are associated with AKI, such as cardiocirculatory surgeries, polytraumatism, septicemia, use of contrast, bleeding, among others. [3][4][5][6] The high mortality rate of these pathologies, especially in ICU, brings out the need for attention for this disease. [1][2][3][4][5][6][7] Studies on chronic kidney diseases have shown the importance of ethnical, 8 environmental, 9,10 socioeconomical, [11][12][13][14][15] and psychic factors, modulating the disease, its complications and progonosis.…”

“…[3][4][5][6] The high mortality rate of these pathologies, especially in ICU, brings out the need for attention for this disease. [1][2][3][4][5][6][7] Studies on chronic kidney diseases have shown the importance of ethnical, 8 environmental, 9,10 socioeconomical, [11][12][13][14][15] and psychic factors, modulating the disease, its complications and progonosis. 16 Many investigations have demonstrated that chronic stress conditions are associated with allostatic overload, 17,18 that is, the attempt of the body to find stability through stressful change, thus leading to changes in cortisol and insulin levels, in the hypothalamo-hypophyseal axis (HPA), kinins, and other proinflammatory elements, among other homeostatic changes.…”