Risk factors and outcome of hospital-acquired acute renal failure

Shusterman, Neil H.; Strom, Brian L.; Murray, Thomas G.; Morrison, Gail; West, Suzanne L.; Maislin, Greg

doi:10.1016/0002-9343(87)90498-0

Cited by 325 publications

(62 citation statements)

References 14 publications

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“…Septicaemia accounts for 2% to 8% cases of ARF and a higher incidence has been reported in hospital acquired ARF [4]. The older age group, multiple therapeutic and diagnostic procedures and prolonged hospitalisation probably accounted for the increased incidence of septicaemia.…”

Section: Discussionmentioning

confidence: 99%

Acute Renal Failure – Changing Trends

Narula

Bhangui

1994

Medical Journal Armed Forces India

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A prospectivestudy of120 patients ofacute renal failure was done at CH (EelCalcutta to document the changingtrends in the incidence and etiology ofacute renal failure and to assess the prognosticfactors. Mean age of patients was 33.7 ± 20.2 years. 75% had a medicalrisk factor. The etiological factors were volume depletion (13.3%), septicaemia (25.6%). falciparum malaria (16.6%), a transplant related renal failure (5.7%) and drugs (16.7%). Renalhistology showedacute tubular necrosis to be the most common lesion(53.3 %). In 13.3%patients whodied withacuterenal failure.associatedinfectionand multisystem involvementwas more common.

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Section: Discussionmentioning

confidence: 99%

Acute Renal Failure – Changing Trends

Narula

Bhangui

1994

Medical Journal Armed Forces India

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“…The oft-cited study by Hou et al (23) reported an ARF incidence estimate of 4.9%. Shusterman et al (24) conducted a similar study identifying ARF in 1.9% of hospitalized patients. A follow-up study recently published by Hou and colleagues (43) showed an increase in incidence (7%), but a similar spectrum of risk factors.…”

Section: Epidemiology Of Acute Renal Failurementioning

confidence: 97%

“…For instance, the transition from sepsis to severe sepsis requires the presence of sepsis-related organ dysfunction. These graded (24) 0.9 mg/dl increase in SCr if baseline SCr Ͻ2.0 mg/dl, or 1.5 mg/dl increase in SCr if baseline SCr Ն2.0 mg/dl, and "remained elevated for at least one additional consecutive determination"…”

Section: Analogous Definitions In Other Conditionsmentioning

confidence: 99%

“…Several other agents are now in advanced stages of development or initial phases of clinical trials (18,19). In concert, advances in dialysis have occurred with the availability of continuous renal replacement therapies in addition to intermittent hemodialysis and acute peritoneal dialysis (20 -22).It is well recognized that uncomplicated ARF can usually be managed outside the intensive care unit (ICU) setting and carries a good prognosis, with mortality rates less than 5% to 10% (23,24). In contrast, ARF complicating nonrenal organ system failure in the ICU setting is associated with mortality rates of 50% to 70%, which has not changed for several decades (6,(25)(26)(27)(28)(29)(30).…”

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confidence: 99%

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Acute Renal Failure Definitions and Classification

Mehta¹,

Chertow

2003

Journal of the American Society of Nephrology

304

192

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The development of acute renal failure (ARF) in the hospital setting continues to be associated with poor outcomes (1-7). Over the last three decades, several experimental models have identified pathophysiologic mechanisms associated with ARF and have enhanced our understanding of the disease (8 -10). It is evident that ARF can result from alterations in renal perfusion, changes in glomerular filtration, and tubular dysfunction, and that correction of these factors can ameliorate the effects of ARF (11,12). On the basis of the identification of the underlying mechanisms, several new potential interventions have been developed that have been shown to alter the course of incipient and established ARF in experimental models (13)(14)(15). Application of these findings has resulted in improvements in the prevention of ARF due to radiocontrast agents, aminoglycoside antibiotics, and rhabdomyolysis (16,17). Several other agents are now in advanced stages of development or initial phases of clinical trials (18,19). In concert, advances in dialysis have occurred with the availability of continuous renal replacement therapies in addition to intermittent hemodialysis and acute peritoneal dialysis (20 -22).It is well recognized that uncomplicated ARF can usually be managed outside the intensive care unit (ICU) setting and carries a good prognosis, with mortality rates less than 5% to 10% (23,24). In contrast, ARF complicating nonrenal organ system failure in the ICU setting is associated with mortality rates of 50% to 70%, which has not changed for several decades (6,(25)(26)(27)(28)(29)(30). These figures are in sharp contrast to the experience with acute myocardial infarction (AMI), where in-hospital mortality rates have declined from the range of 50% to approximately 6% over the past 25 to 30 yr. Much of the credit for improved AMI outcomes has been attributed to the use of coronary care units, cardiac catheterization, aspirin, ␤-adrenergic antagonists, thrombolytic therapy, and, more recently, specialized percutaneous coronary interventions and glycoprotein IIb-IIIa inhibitors (31-34). In spite of improved dialytic technology, including the development and refinement of continuous renal replacement therapies for the most critically ill patients, we have seen no material change in the high mortality rates associated with ARF. Indeed, we have not demonstrated any pharmacologic or other intervention effective in the early management of ARF. Interventions that have been deemed ineffective (or potentially harmful) include the following: loop and osmotic diuretic agents (35,36), "renal dose" dopamine (37,38), atrial natriuretic peptide (39,40), insulin-like growth factor-1 (41), and endothelin receptor antagonists (42).Although ARF may develop in 5% or more of hospitalized patients, the heterogeneity of ARF and associated comorbidity make its study more difficult than AMI and other, more discrete conditions. Among the impediments to progress in ARF research is the lack of a uniform definition of ARF that might be used to comp...

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“…Hospital-acquired AKI (HA-AKI) has been reported in 1% to 7% of hospitalized patients on the basis of several single-center reports (2)(3)(4)(5)(6)(7). One great challenge is to identify at-risk patients for HA-AKI, strategies for prevention and treatment of AKI in these patients, and appropriate use of healthcare resources (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Referral Patterns and Outcomes in Noncritically Ill Patients with Hospital-Acquired Acute Kidney Injury

Meier¹,

Bonfils²,

Vogt³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Despite modern treatment, the case fatality rate of hospital-acquired acute kidney injury (HA-AKI) is still high. We retrospectively described the prevalence and the outcome of HA-AKI without nephrology referral (nrHA-AKI) and late referred HA-AKI patients to nephrologists (lrHA-AKI) compared with early referral patients (erHA-AKI) with respect to renal function recovery, renal replacement therapy (RRT) requirement, and in-hospital mortality of HA-AKI.Design, setting, participants, & measurements Noncritically ill patients admitted to the tertiary care academic center of Lausanne, Switzerland, between 2004 and in the medical and surgical services were included. Acute kidney injury was defined using the Acute Kidney Injury Network (AKIN) classification.Results During 5 years, 4296 patients (4.12% of admissions) experienced 4727 episodes of HA-AKI during their hospital stay. The mean Ϯ SD age of the patients was 61 Ϯ 15 years with a 55% male predominance. There were 958 patients with nrHA-AKI (22.3%) and 2504 patients with lrHA-AKI (58.3%). RRT was required in 31% of the patients with lrHA-AKI compared with 24% of the patients with erHA-AKI. In the multiple risk factor analysis, compared with erHA-AKI, nrHA-AKI and lrHA-AKI were significantly associated with worse renal outcome and higher in-hospital mortality.Conclusions These data suggest that HA-AKI is frequent and the patients with nrHA-AKI or lrHA-AKI are at increased risk for in-hospital morbidity and mortality.

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Risk factors and outcome of hospital-acquired acute renal failure

Cited by 325 publications

References 14 publications

Acute Renal Failure – Changing Trends

Acute Renal Failure – Changing Trends

Acute Renal Failure Definitions and Classification

Referral Patterns and Outcomes in Noncritically Ill Patients with Hospital-Acquired Acute Kidney Injury

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