Research
Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study
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* Corresponding author: Kevin B Laupland Kevin.Laupland@CalgaryHealthRegion.ca
1 Fellow, Departments of Critical Care Medicine, and Community Health Sciences, Calgary Health Region and University of Calgary, Calgary Alberta, Canada
2 Assistant Professor, Departments of Critical Care Medicine, Medicine, Community Health Sciences and Pathology and Laboratory Medicine, Calgary Health Region and University of Calgary, Calgary Alberta, Canada
3 Associate Professor, Departments of Critical Care Medicine, Medicine and Community Health Sciences, Calgary Health Region and University of Calgary, Calgary Alberta, Canada
4 Clinical Assistant Professor, Department of Medicine, Calgary Health Region and University of Calgary, Calgary Alberta, Canada
5 Professor, Department of Community Health Sciences, Calgary Health Region and University of Calgary, Calgary Alberta, Canada
6 Research Assistant, Department of Medicine, Calgary Health Region and University of Calgary, Calgary Alberta, Canada
7 Clinical Assistant Professor, Departments of Critical Care Medicine and Medicine, Calgary Health Region and University of Calgary, Calgary Alberta, Canada
8 Associate Professor, Department of Community Health Sciences, Calgary Health Region and University of Calgary, Calgary Alberta, Canada
9 Epidemiologist, Health Surveillance Branch, Alberta Health and Wellness, Edmonton Alberta, Canada
10 Associate Professor, Department of Public Health Sciences, University of Alberta, Edmonton Alberta, Canada
11 Associate Professor, Departments of Medicine and Community Health Sciences, Calgary Health Region and University of Calgary, Calgary Alberta, Canada
Critical Care 2005, 9:R700-R709 doi:10.1186/cc3879
Published: 25 October 2005Abstract
Introduction
Severe acute renal failure (sARF) is associated with considerable morbidity, mortality and use of healthcare resources; however, its precise epidemiology and long-term outcomes have not been well described in a non-specified population.
Methods
Population-based surveillance was conducted among all adult residents of the Calgary Health Region (population 1 million) admitted to multidisciplinary and cardiovascular surgical intensive care units between May 1 1999 and April 30 2002. Clinical records were reviewed and outcome at 1 year was assessed.
Results
sARF occurred in 240 patients (11.0 per 100,000 population/year). Rates were highest in males and older patients (≥65 years of age). Risk factors for development of sARF included previous heart disease, stroke, pulmonary disease, diabetes mellitus, cancer, connective tissue disease, chronic renal dysfunction, and alcoholism. The annual mortality rate was 7.3 per 100,000 population with rates highest in males and those ≥65 years. The 28-day, 90-day, and 1-year case-fatality rates were 51%, 60%, and 64%, respectively. Increased Charlson co-morbidity index, presence of liver disease, higher APACHE II score, septic shock, and need for continuous renal replacement therapy were independently associated with death at 1 year. Renal recovery occurred in 78% (68/87) of survivors at 1 year.
Conclusion
sARF is common and males, older patients, and those with underlying medical conditions are at greatest risk. Although the majority of patients with sARF will die, most survivors will become independent from renal replacement therapy within a year.