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Study examines global prevalence of kidney failure among critically ill patients
August 17, 2005A multinational study has found that 5 to 6 percent of patients in intensive care units experience acute kidney failure, and about 60 percent of these patients die in the hospital, according to an article in the August 17 issue of JAMA.
The epidemiology and outcome of acute renal (kidney) failure (ARF) in critically ill patients in different regions of the world have not been well understood, according to background information in the article.
Shigehiko Uchino, M.D., of Austin Hospital, Melbourne, Australia, and colleagues conducted a study to determine the prevalence of ARF in intensive care unit (ICU) patients at 54 hospitals in 23 countries. The ICU patients were either treated with renal replacement therapy (RRT), such as dialysis, or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001.
Of 29,269 critically ill patients admitted during the study period, 1,738 (5.7 percent) had ARF during their ICU stay, including 1,260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5 percent). Approximately 30 percent of patients had preadmission renal dysfunction. The overall hospital death rate was 60.3 percent. Dialysis dependence at hospital discharge was 13.8 percent for survivors. Independent risk factors for hospital death included use of vasopressors (drugs that produce a rise in blood pressure), mechanical ventilation, septic shock, cardiogenic shock, and hepatorenal syndrome (kidney failure combined with severe liver disease).
"In summary, we have conducted a multinational, multicenter, prospective, epidemiological study of ARF that includes the largest and most representative sample of ICUs and ARF patients so far," the authors write. "This information may be helpful in the design of future international interventional trials, which would apply to worldwide practice, in regard to the statistical power and choice of appropriate outcome measures."
JAMA and Archives Journals
Of 29,269 critically ill patients admitted during the study period, 1,738 (5.7 percent) had ARF during their ICU stay, including 1,260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5 percent). Approximately 30 percent of patients had preadmission renal dysfunction. The overall hospital death rate was 60.3 percent. Dialysis dependence at hospital discharge was 13.8 percent for survivors. Independent risk factors for hospital death included use of vasopressors (drugs that produce a rise in blood pressure), mechanical ventilation, septic shock, cardiogenic shock, and hepatorenal syndrome (kidney failure combined with severe liver disease).
"In summary, we have conducted a multinational, multicenter, prospective, epidemiological study of ARF that includes the largest and most representative sample of ICUs and ARF patients so far," the authors write. "This information may be helpful in the design of future international interventional trials, which would apply to worldwide practice, in regard to the statistical power and choice of appropriate outcome measures."
JAMA and Archives Journals
Kidney Failure Current Events and Kidney Failure News RSSDiabetes surgery summit consensus lays foundation for new field of medicine
A first-of-its-kind consensus statement on diabetes surgery is published online today in the Annals of Surgery.
Key player identified in cascade that leads to hypertension-related kidney damage
A key player in a cascade that likely begins with stress and leads to high blood pressure and kidney damage has been identified by researchers who say the finding may lead to better ways to control both.
Kidney transplants generally safe for lupus patients
Individuals with a history of lupus who receive a kidney transplant rarely develop the serious inflammatory condition lupus nephritis in their new organ, according to a paper being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, CA.
A decade later, lifestyle changes or metformin still lower type 2 diabetes risk
Intensive lifestyle changes aimed at modest weight loss reduced the rate of developing type 2 diabetes by 34 percent compared with placebo in people at high risk for the disease, researchers conclude based on 10 years of data.
Calculate benefit before dialysis for frail elders
Kidney specialists should weigh the potential quality of life for frail elders with end-stage renal disease (ESRD) in opting for dialysis over more conservative therapies, a nephrologist and a palliative care specialist suggest in an editorial in the New England Journal of Medicine.
Study questions need for routine intervention in patients with renovascular disease
Some invasive procedures that are becoming increasingly common as a first line of treatment for patients diagnosed with narrowed arteries in and around the kidneys may not be necessary.
Ironing out the genetic cause of hemoglobin problems
A gene with a significant effect on regulating hemoglobin in the body has been identified as part of a genome-wide association study, which looked at the link between genes and hemoglobin level in 16,000 people.
National report shines light on lupus 50-year treatment drought
Today, The Lewin Group, a national health care consulting firm, issued recommendations on ways to overcome the barriers that have obstructed lupus drug development resulting in no new drug approval for this disease in more than 50 years - since the Eisenhower Administration.
Kidneys from deceased donors with acute renal failure expand donor pool
Kidneys recovered from deceased donors with acute renal failure (ARF) - once deemed unusable for transplant - appear to work just as well as kidneys transplanted from deceased donors who do not develop kidney problems prior to organ donation.
Study details safe, effective, minimally invasive mitral valve repair
Surgical treatment for mitral valve disease includes either repairing the patient's diseased valve or replacing it with a metal, mechanical valve or an animal tissue valve.
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