Improvement in Prognosis of Patients with Acute Renal Failure over a Period of 15 Years: An Analysis of 710 Cases in a Dialysis Center

Abstract

In order to evaluate the changes in causes and outcome of acute renal failure (ARF) during the years 1975-1989, 710 patients treated in our dialysis center were analyzed. We compared the etiology, the severity and catabolic state of ARF, the techniques of renal replacement therapy, which were employed and the ages and mortality rates of these patients, who received dialysis therapy during the years 1975-79 (n = 227), 1980-84 (n = 240) and 1985-89 (n = 243). The number of postoperative, posttraumatic and non-traumatic cases of ARF was approximately the same in all three 5-year periods, only the frequency of postrenal failure decreased from 7% in the years 1975-79 to 3% in the years 1985-89. The incidence of sepsis as a major cause of ARF and the most important risk factor was comparably high in the surgical and medical patients during all of the periods, but it increased in the traumatic patients from 7 % in the years 1975-79 to 28 % during the last 5-year period. The prevalence of respiratory failure and jaundice as additional organ failures, the severity of ARF (oligonanuric-nonoliguric) and the metabolic state were not different in the three patient groups. The magnitude of rise in serum creatinine before the start of renal replacement therapy was significant lower in the last 5-year period in comparison to the years 1975-79 (p < 0.05). Hemodialysis was the treatment in choice of 98 and 93 % of the cases during the first two periods, respectively. Since 1980, bicarbonate was employed in the dialysis instead of acetate in the most cases. In the years 1985-89, hemodialysis was only performed in 51 % of the patients, intermittent or continuous hemofiltration was used in 49%. The mortality of all the patients was reduced from 69% in the years 1975-79 to 54 and 48%, respectively, in the last two 5-year periods (p < 0.01), though the mean age of the patients has increased from 44 (9-84) to 57 (10-84) and 58 years (15-90), respectively. This improvement in outcome has been demonstrated in surgical and traumatic as well as nontraumatic and postrenal failure.

Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002

“…Previous studies that examined trends in ARF-associated outcomes have yielded a spectrum of conclusions, with reports of a decline (11,12,14,16,17), increase (15), and no change in in-hospital mortality (13). These studies generally have been limited by relatively small sample sizes and reliance on a single center's experience.…”

“…A systematic review of 80 studies of ARF involving 15,897 patients between 1970 and 2004 concluded that mortality rates have remained unchanged (10). The handful of studies that have specifically examined mortality rates of ARF over time have been small (N Յ 710) and have yielded conflicting conclusions (11)(12)(13)(14)(15)(16)(17). Using the Nationwide Inpatient Sample (NIS), a large and nationally representative administrative database of hospital discharges from 1988 to 2002, we attempted to determine secular trends in the incidence, inhospital mortality, length of stay (LOS), and disposition (discharge to home versus posthospital care) for patients with ARF and ARF-D.…”

Prognosis of Acute Renal Failure 1975-1995

“…Biesenbach et al [50] studied the prognosis of patients with ARF requiring dialysis (in recent years continuous hemofiltration) between 1975 and 1989. This report is especially relevant to the discussion of the evaluation of prognosis during the last decades.…”

Clinical characterization of acute renal failure in multiple organ dysfunction syndrome

“…Multiple factors relate to an effect on the prognosis, but advance in blood purification technology, 13 particularly an increase in the number of patients treated by continuous hemodiafiltration, is one of the main factors underlying the improved prognosis. i4 This may be related to the fact that treatment by continuous hemodiafiltration, even in patients with acute renal failure, provides continuous transfusion of a high-calorie fluid that maintains the dynamic state of the body fluids, and maintains constancy of the acid-base balance of the blood.…”