Hatem O Qutub, MD(*) and I Saeed, MD. King Fahd Hospital of the University, Al Khobar, Saudi Arabia.
PURPOSE: To determine the clinical course of Acute Renal Failure (ARF) in an Intensive Care Unit (ICU) setup.
METHODS: All patients admitted to the ICU who developed ARF were prospectively studied over a three-year period (1996-1999). They were investigated for the causes of their ARK given appropriate treatment and their course carefully documented until discharge from the ICU.
RESULTS: 47 patients (29 male, 18 female) were studied. They were mostly Saudi (80%). The age range was 28-68 years with a mean of 44.5 years. Renal causes, 31 cases (66%), were the most frequent cause of ARF. Pre-renal causes occurred in 12 cases (25.5%) and post-renal causes in 4 cases (8.5%). Three quarters of the causes were medical and one quarter surgical. Septicemia(22 cases), dehydration with hypovolemia (8 cases) and myo/hemoglobinuria were the common medical causes. 15 patients (31.9%) died in the ICU while 32 were discharged alive. Multiple organ failure (MOF), disseminated intravascular coagulopathy (DIC), acute respiratory distress syndrome (ARDS), and diabetes mellitus (DM) were the major factors that adversely affect mortality. There was a statistically significant difference in the length of stay of the survivors (5.7 [+ or -] 2.6 days) compared to the dead (11 [+ or -] 5.8 days) (P [is less than] 0.002). Renal replacement therapy (RRT) was performed in 15 patients (11 continuous venous venous hemodialysis and 5 hemodialysis). Almost three-quarter (73.3%) of the dead required RRT.
CONCLUSION: The development of ARF in the setting of ICU carried a poor prognosis. Renal causes are responsible for 2 in 3 cases, while MOP, DIC, ARDS, and DM increase mortality.
CLINICAL IMPLICATIONS: The poor prognosis of patients developing ARF in the ICU can be improved if attention is paid to prevention of septicemia, dehydration and prompt and aggressive treatment of MOP, DIC, ARDS and DM.
GRANT SUPPORT: Not funded
COPYRIGHT 2000 American College of Chest Physicians
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