Acute Renal Failure in Critically Ill Patients
A Multinational, Multicenter Study
- Shigehiko Uchino, MD;
- John A. Kellum, MD;
- Rinaldo Bellomo, MD;
- Gordon S. Doig, PhD;
- Hiroshi Morimatsu, MD;
- Stanislao Morgera, MD;
- Miet Schetz, MD;
- Ian Tan, MD;
- Catherine Bouman, MD;
- Ettiene Macedo, MD;
- Noel Gibney, MD;
- Ashita Tolwani, MD;
- Claudio Ronco, MD;
- for the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators
- Author Affiliations: Departments of Intensive Care and Surgery, Austin Hospital, Melbourne, Australia (Drs Uchino, Bellomo, and Morimatsu); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Kellum); Department of Medicine, University of Sydney and Royal North Shore Hospital, Sydney, Australia (Dr Doig); Department of Nephrology, University Hospital Charité, Berlin, Germany (Dr Morgera); Dienst Intensieve Geneeskunde, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium (Dr Schetz); Intensive Care Unit, Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (Dr Tan); Adult Intensive Care Unit, Academic Medical Center, Amsterdam, the Netherlands (Dr Bouman); Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil (Dr Macedo); Division of Critical Care Medicine, University of Alberta, Edmonton (Dr Gibney); Department of Medicine, Division of Nephrology, University of Alabama, Birmingham (Dr Tolwani); and Nephrology/Intensive Care, St Bortolo Hospital, Vicenza, Italy (Dr Ronco).
- Corresponding Author: John A. Kellum, MD, CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15261 (kellumja{at}ccm.upmc.edu).
Abstract
Context Although acute renal failure (ARF) is believed to be common in the setting of critical illness and is associated with a high risk of death, little is known about its epidemiology and outcome or how these vary in different regions of the world.
Objectives To determine the period prevalence of ARF in intensive care unit (ICU) patients in multiple countries; to characterize differences in etiology, illness severity, and clinical practice; and to determine the impact of these differences on patient outcomes.
Design, Setting, and Patients Prospective observational study of ICU patients who either were treated with renal replacement therapy (RRT) or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001 at 54 hospitals in 23 countries.
Main Outcome Measures Occurrence of ARF, factors contributing to etiology, illness severity, treatment, need for renal support after hospital discharge, and hospital mortality.
Results Of 29 269 critically ill patients admitted during the study period, 1738 (5.7%; 95% confidence interval [CI], 5.5%-6.0%) had ARF during their ICU stay, including 1260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5%; 95% CI, 45.2%-49.5%). Approximately 30% of patients had preadmission renal dysfunction. Overall hospital mortality was 60.3% (95% CI, 58.0%-62.6%). Dialysis dependence at hospital discharge was 13.8% (95% CI, 11.2%-16.3%) for survivors. Independent risk factors for hospital mortality included use of vasopressors (odds ratio [OR], 1.95; 95% CI, 1.50-2.55; P<.001), mechanical ventilation (OR, 2.11; 95% CI, 1.58-2.82; P<.001), septic shock (OR, 1.36; 95% CI, 1.03-1.79; P = .03), cardiogenic shock (OR, 1.41; 95% CI, 1.05-1.90; P = .02), and hepatorenal syndrome (OR, 1.87; 95% CI, 1.07-3.28; P = .03).
Conclusion In this multinational study, the period prevalence of ARF requiring RRT in the ICU was between 5% and 6% and was associated with a high hospital mortality rate.
