Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients*

Metnitz, Philipp; Krenn, Claus G.; Steltzer, H.; Lang, Thomas; Ploder, Jürgen; Lenz, Kurt; Gall, Jean-Roger Le; Druml, Wilfred

doi:10.1097/00003246-200209000-00016

Cited by 824 publications

(515 citation statements)

References 27 publications

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“…The ARF is defined, in most studies, as when there is elevation in the creatinine level between 1.3 mg/dl and 5.0 mg/dl, or when there is a need for dialysis treatment (8)(9)(12)(13)(14) . In this study, it was considered as serum creatinine levels greater than 1.5 mg/dl (11)(12) .…”

Section: Discussionmentioning

confidence: 99%

Evolução clínica de pacientes com insuficiência renal aguda em unidade de terapia intensiva

et al. 2008

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Objective: To evaluate the clinical outcome of acute renal failure (ARF) patients when submitted to dialysis and non-dialysis treatments in ICU. Methods: this prospective study included patients over 18 years of age and serum creatinine of >1.5 mg/dl. The patients were included in dialysis and non-dialysis groups. Results: The study included 70 patients, 19 (27.1%) comprised the dialysis group and 51 (72.9%) the non-dialysis group. In the dialysis group, mortality rate was 42.1% and in the non-dialysis group was 33.3% (p<0.58). Conclusion: There were multifactors of ARF in ICU, but ARF is not the single cause for the high mortality rate in ICU patients. Keywords: Renal insufficiency, acute/therapy; Renal insufficiency, acute/epidemiology; Intensive care units; Nursing RESUMOObjetivo: Avaliar a evolução clínica de pacientes com insuficiência renal aguda (IRA) submetidos a tratamento dialítico e não-dialítico na UTI. Métodos: Estudo prospectivo onde foram incluídos pacientes com idade maior que 18 anos e com creatinina sérica > 1,5 mg/dl. Os pacientes foram divididos em grupo dialítico e não-dialítico. Resultados: Dos 70 pacientes incluídos 19 (27,1%) foram do grupo dialítico e 51 (72,9%) do grupo não-dialítico. A taxa de mortalidade foi de 42,1% no grupo dialítico e de 33,3% no grupo não-dialítico (p<0,58). Conclusão: Há multifatores determinando a IRA na UTI, porém, não é causa isolada das elevadas taxas de mortalidade dos pacientes na UTI. Descritores: Insuficiência renal aguda/terapia; Insuficiência renal aguda /epidemiologia; Unidades de terapia intensiva; Enfermagem RESUMEN Objetivo: Evaluar la evolución clínica de pacientes con insuficiencia renal aguda (IRA) sometidos a tratamiento dialítico y no-dialítico en la UCI. Métodos: Se trata de un estudio prospectivo donde fueron incluídos pacientes mayores de 18 años y con creatinina sérica > 1,5 mg/ dl. Los pacientes fueron divididos en grupo dialítico y no-dialítico. Resultados: De los 70 pacientes incluídos 19 (27,1%) fueron del grupo dialítico y 51 (72,9%) del grupo no-dialítico. La tasa de mortalidad fue del 42,1% en el grupo dialítico y del 33,3% en el grupo no-dialítico (p<0,58). Conclusion: Hay multifactores que determinan la IRA en la UCI, sin embargo, no es causa aislada de las elevadas tasas de mortalidad de los pacientes en la UCI.

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Section: Discussionmentioning

confidence: 99%

Evolução clínica de pacientes com insuficiência renal aguda em unidade de terapia intensiva

et al. 2008

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“…AKI is common in critically ill patients and remains associated with poor outcomes (1)(2)(3). The main known risk factors for AKI in critically ill patients are absolute or relative hypovolemia, nephrotoxic drug exposure, sepsis, and comorbidities (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome and Risk of AKI among Critically Ill Patients

Darmon¹,

Clec’h²,

Adrie³

et al. 2014

Clinical Journal of the American Society of Nephrology

170

159

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Background and objectives Increasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients.Design, setting, participants, & measurements This was an observational study on a prospective database fed by 18 intensive care units (ICUs). Patients with ICU stays .24 hours were enrolled over a 14-year period. ARDS was defined using the Berlin criteria and AKI was defined using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria. Patients with AKI before ARDS onset were excluded.Results This study enrolled 8029 patients, including 1879 patients with ARDS. AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS; P,0.001). After adjustment for confounders, both mechanical ventilation without ARDS (odds ratio [OR], 4.34; 95% confidence interval [95% CI], 3.71 to 5.10) and ARDS (OR, 11.01; 95% CI, 6.83 to 17.73) were independently associated with AKI. Hospital mortality was 14.2% (n=1140) and was higher in patients with ARDS (27.9% versus 10.0% in patients without ARDS; P,0.001) and in patients with AKI (27.6% versus 8.1% in those without AKI; P,0.001). AKI was associated with higher mortality in patients with ARDS (42.3% versus 20.2%; P,0.001).Conclusions ARDS was independently associated with AKI. This study suggests that ARDS should be considered as a risk factor for AKI in critically ill patients.

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“…acute kidney injury; acute lung injury; acute respiratory distress syndrome; biological marker; predictive value; interleukin-6; soluble tumor necrosis factor receptor; plasminogen activator inhibitor-1 Acute kidney injury (also known as acute renal failure) in hospitalized patients is associated with high mortality, often 40-60% in the critical care setting (1)(2)(3)(4). New therapies that reduce the morbidity and mortality of acute kidney injury are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury*

Liu

Glidden

Eisner

et al. 2007

Critical Care Medicine

145

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Objective-To identify biological and clinical predictors of acute kidney injury in subjects with acute lung injury.Design-Secondary data analysis from a multicenter, randomized clinical trial. Setting-Intensive care units in ten university medical centers.Patients-A total of 876 patients enrolled in the first National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Network trial.Interventions-Study subjects were randomized to receive a low tidal volume ventilation strategy and pharmacologic therapy with ketoconazole or lisofylline in a factorial design. Measurements and MainResults-We tested the association of baseline levels of interleukin-6, interleukin-8, interleukin-10, von Willebrand factor, tumor necrosis factor-α, type I and II soluble tumor necrosis factor receptors (sTNFR-I and -II), protein C, plasminogen activator inhibitor-1 (PAI-1), surfactant protein-A, surfactant protein-D, and intracellular adhesion molecule-1 with subsequent acute kidney injury. Of 876 study participants who did not have endstage renal disease, 209 (24%) developed acute kidney injury, defined as a rise in serum creatinine of >50% from baseline over the first four study days. The 180-day mortality rate for subjects with acute kidney injury was 58%, compared with 28% in those without acute kidney injury (p < .001). Interleukin-6, sTNFR-I, sTNFR-II, and PAI-1 levels were independently associated with acute kidney injury after adjustment for demographics, interventions, and severity of illness. A combination of clinical and biological predictors had the best area under the receiver operating characteristic curve, and the contribution of sTNFR-I and PAI-1 to this model was highly significant (p = .0003). Dr. Chertow is a scientific advisor to RenaMed Biologic, Westborough, MA. The remaining authors have not disclosed any potential conflicts of interest. NIH Public Access Author ManuscriptCrit Care Med. Author manuscript; available in PMC 2012 March 5. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusions-Elevations in PAI-1, interleukin-6, and the sTNFRs in subjects with acute kidney injury suggest that disordered coagulation, inflammation, and neutrophil-endothelial interactions play important roles in the pathogenesis of acute kidney injury. The combination of these biological and clinical risk factors may have important and additive value in predictive models for acute kidney injury. Keywordsacute kidney injury; acute lung injury; acute respiratory distress syndrome; biological marker; predictive value; interleukin-6; soluble tumor necrosis factor receptor; plasminogen activator inhibitor-1Acute kidney injury (also known as acute renal failure) in hospitalized patients is associated with high mortality, often 40-60% in the critical care setting (1-4). New therapies that reduce the morbidity and mortality of acute kidney injury are urgently needed. Dialysis only manages the symptoms, rather than treating the injury (5).An important limitation to the treatment of ...

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Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients*

Cited by 824 publications

References 27 publications

Evolução clínica de pacientes com insuficiência renal aguda em unidade de terapia intensiva

Evolução clínica de pacientes com insuficiência renal aguda em unidade de terapia intensiva

Acute Respiratory Distress Syndrome and Risk of AKI among Critically Ill Patients

Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury*

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