Causes and Prognosis of Acute Renal Failure in the Very Old

Pascual, Julio; Liaño, Fernando

doi:10.1111/j.1532-5415.1998.tb03807.x

Cited by 99 publications

(62 citation statements)

References 26 publications

(43 reference statements)

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“…The need for RRT resulted in a 6 times increased odds for dismal outcome. This is an affirmation of data from the recent literature showing that patients who needed RRT had a significantly higher mortality compared with patient groups without need for RRT (2)(3)(4)11,17,18,20,22,35). It underlines the importance of further research regarding the optimal timing, dose, and mode of RRT.…”

Section: Discussionmentioning

confidence: 48%

“…Data in the literature are ambiguous on this point. Two community-based studies found that older age was associated with a higher incidence of ARF (11,40). In a general medical ICU population and in a population of patients undergoing myocardial revascularization, age was an independent factor associated with the development of ARF in multivariable analysis (14,24,35).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute Renal Failure in Patients with Sepsis in a Surgical ICU

Hoste¹,

Lameire²,

Vanholder³

et al. 2003

Journal of the American Society of Nephrology

379

234

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Abstract. Acute renal failure (ARF) is a common complication in intensive care unit (ICU) patients. Although there are several reports on outcome of septic patients with ARF, there are no data regarding predisposing factors for ARF. Therefore, the incidence of ARF was investigated in 185 sepsis patients admitted in a surgical ICU during a 16-mo period. Variables predisposing to ARF on day 1 of sepsis were evaluated with univariate and multivariable analyses. APACHE II and SOFA scores were compared during a 14-d period. Additionally, the impact of organ failure on mortality was evaluated. ARF developed in 16.2% of the patients, and 70.0% of these needed renal replacement therapy (RRT). Patients with ARF were more severely ill and had a higher mortality. Remarkably, serum creatinine was already increased on day 1. Creatinine Ͼ 1 mg/dl and pH Ͻ 7.30, both on day 1 of sepsis, were independently associated with ARF. Age, need for vasoactive therapy, mechanical ventilation, and RRT, but not ARF itself, were associated with mortality. In conclusion, ARF was a frequent complication in sepsis. Sepsis patients with ARF were more severely ill and had a higher mortality. Need for RRT was independently associated with mortality. A simple risk model for ARF, on basis of two readily available parameters on day 1 of sepsis, was developed. This model allows initiating specific therapeutic measures earlier in the course of sepsis, hopefully resulting in a lower incidence of ARF and needi for RRT, thereby lowering mortality.Acute renal failure (ARF) is a common complication in patients admitted to the intensive care unit (ICU). Numerous causes are responsible for the development of ARF (1); moreover, ARF has often a multi-factorial etiology in critically ill patients. The relative importance of factors contributing to ARF will be different depending on the underlying pathology and patient characteristics. A patient population of young trauma patients developing ARF can probably not be compared with older patients with ischemic and congestive heart disease developing ARF after cardiac surgery. The large differences in mortality for patients with ARF, as reported in recent trials (varying between 28 and 83%) can possibly be explained by differences in patient population (2-25). On the other hand, the relatively stable mortality of patients with ARF over the past decades, despite advances in critical and renal care, is attributed to the changing pattern of associated pathology and patient populations (26 -29).Analysis of a well-described subgroup of ICU patients (e.g., patients after cardiac surgery or sepsis patients) can reveal more precise information concerning the epidemiology and risk factors for development of ARF.Sepsis is a common condition with an annual death toll in the United States comparable to that of acute myocardial infarction (30). Sepsis is also a well-known risk factor for the development of ARF, and 35 to 50% of ARF cases in the ICU can be attributed to sepsis (2,12,20,23). Mortality in this subgroup of patients...

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Acute Renal Failure in Patients with Sepsis in a Surgical ICU

Hoste¹,

Lameire²,

Vanholder³

et al. 2003

Journal of the American Society of Nephrology

379

234

View full text Add to dashboard Cite

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“…Studies that have specifically compared prognosis of ARF in elderly versus young over the recent years suggest that the prognosis may not be worse among the elderly. Shortcomings among these studies were the possible inclusion of less critically ill patients in the elderly group, [18] a retrospective analysis and failure to compare severity as well as causes of ARF among the two groups, [19] and inclusion of pre-renal and obstructive ARF, which are known to have a better prognosis. [20] This study was prospective and included only cases of intrinsic ARF.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Mortality in Acute Renal Failure in a Developing Country: A Prospective Study

et al. 2007

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Acute renal failure (ARF) occurs in wide range of conditions, making the evaluation of its prognosis a difficult task. Data regarding prognostic factors in ARF in a general population in developing countries are scarce. The objective of the study was to describe predictors of mortality in ARF that are relevant in the developing world. This prospective study was carried out over a one-year period; all hospitalized adults with ARF were included in the study. Predictors of mortality studied included causes of ARF, pre-existing diseases, and severity as well as complications of ARF. Of 33,301 patients admitted during the study period, 294 (0.88%) were either admitted with or developed ARF after hospitalization. Mean age was 43.9 ± 16.9 (18-86 yrs). Sepsis was the most common cause (63.26%). Pre-existing diseases like cardiovascular disease (CVSD), respiratory system disease (RSD), central nervous system disease (CNSD), hypertension, diabetet mellitus (DM), and malignancy were significantly higher in elderly as compared to younger patients. On univariate analysis sepsis, hypoperfusion as a cause of ARF and hospital-acquired ARF were associated with higher mortality. Pre-existing diseases viz. RSD, CVSD, CNSD, and DM had higher mortality. Among the severity and complications of ARF, oliguria, bleeding and infection during the course of ARF and critical illness were predictors of poor outcome. Age >60 yrs was associated with significantly higher mortality. However, on multivariate analysis, only critical illness (odds ratio 37.3), age > 60 years (odds ratio of 5.6), and sepsis as cause of ARF (odds ratio of 2.6) were found to be independent predictors of mortality.

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“…Because life expectancy is longer nowadays, more elder patients have looked for medical services. [16,19,20] ARF occurs more often in the elder population [2,[12][13][14]16,[19][20][21][22][23] with three important factors that affect renal hemodynamic: the physiological aging of renal function, different morbidities regarding this age, and the use of different medications by these patients. [14,18,22,[24][25][26][27] Proximal femur fracture can be intracapsular (fracture of femoral neck) or extracapsular (transtrochanteric), and must be treated with prosthesis substitution and osteosynthesis with plate and screws, respectively.…”

Section: Introductionmentioning

confidence: 99%

“…[1,2,7,8] ARF occurs in 5-7% of all clinical or surgical hospitalized patients, [2,4] and the incidence in the postoperative period ranges from 0.1% to 30%, depending on the criteria to define it and the kind of surgery. [9][10][11][12][13][14][15][16] Of the patients with this complication, nearly 1% can develop severe renal disease with creatinine level above 4 mg.dL −1 or need for dialysis. [17][18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

Postoperative Renal Function Evaluation, through RIFLE Criteria, of Elderly Patients Who Underwent Femur Fracture Surgery under Spinal Anesthesia

Azevedo

Silveira²,

Santos³

et al. 2008

Renal Failure

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Introduction. The postoperative acute renal failure (ARF) incidence in different kinds of surgery has rarely been studied. Age, cardiac dysfunction, previous renal dysfunction, intraoperative hypoperfusion, and use of nephrotoxic medications are mentioned as risk factors for ARF at the postoperative period. The postoperative ARF definition was based on the creatinine increase by the RIFLE classification (R = risk, I = injury, F = failure, L = loss, E = end stage), which corresponds to a 1.5 creatinine increase, two to three times, respectively, above the basal value. This study aimed to evaluate the postoperative ARF incidence in elderly patients who underwent femur fracture surgery under subarachnoid anesthesia and stratify it by the RIFLE criteria. Methods. Ninety patients older than 65 years under spinal anesthesia with fixed dosage of 15 mg of 0.5% isobaric bupivacaine associated with morphine 50 μg were studied. Immediate postoperative creatinine was considered basal and compared with maximal creatinine evaluated at 24, 48, and 72 postoperative hours. Results. The mean age of the patients was 80.27 years. ARF incidence was 24.44% and stratified this way: R = 21.11% and I = 3.33%. Conclusions. In conclusion, the postoperative ARF incidence after femur fracture surgery in patients over 65 years was 24.44%. By analyzing the stratification based on the RIFLE classification, the incidence was categorized as Risk (R) = 21.11% and Injury (I) = 3.33%.

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Causes and Prognosis of Acute Renal Failure in the Very Old

Abstract: Age is not a particularly poor prognostic sign, and outcome seems to be within acceptable limits for very old patients with ARF. Acute dialysis should not be withheld from patients solely because they are more than 80 years of age.

Cited by 99 publications

References 26 publications

Acute Renal Failure in Patients with Sepsis in a Surgical ICU

Acute Renal Failure in Patients with Sepsis in a Surgical ICU

Predictors of Mortality in Acute Renal Failure in a Developing Country: A Prospective Study

Postoperative Renal Function Evaluation, through RIFLE Criteria, of Elderly Patients Who Underwent Femur Fracture Surgery under Spinal Anesthesia

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