Risk Factors Influencing Survival in Acute Renal Failure Treated by Hemodialysis

Lien, Jau Min; Chan, Vivian

doi:10.1001/archinte.1985.00360110143028

Cited by 91 publications

(2 citation statements)

References 16 publications

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“…Because of the increased pulmonary vascular resistance, left and right atrial pressures also changed significantly, and reductions in mean arterial pressures were noted [51]. These studies are similar to those reported by Bourgoin et al [16] and Lien and Chan [52] who found that MAP and arterial pH at 24 h most strongly predicted mortality in patients with renal failure.…”

Section: Discussionsupporting

confidence: 67%

Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study

Lan

Chen

et al. 2021

Medicina

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Background and Objectives: In the intensive care unit (ICU), renal failure and respiratory failure are two of the most common organ failures in patients with systemic inflammatory response syndrome (SIRS). These clinical symptoms usually result from sepsis, trauma, hypermetabolism or shock. If this syndrome is caused by septic shock, the Surviving Sepsis Campaign Bundle suggests that vasopressin be given to maintain mean arterial pressure (MAP) > 65 mmHg if the patient is hypotensive after fluid resuscitation. Nevertheless, it is important to note that some studies found an effect of various mean arterial pressures on organ function; for example, a MAP of less than 75 mmHg was associated with the risk of acute kidney injury (AKI). However, no published study has evaluated the risk factors of mortality in the subgroup of acute kidney injury with respiratory failure, and little is known of the impact of general risk factors that may increase the mortality rate. Materials and Methods: The objective of this study was to determine the risk factors that might directly affect survival in critically ill patients with multiple organ failure in this subgroup. We retrospectively constructed a cohort study of patients who were admitted to the ICUs, including medical, surgical, and neurological, over 24 months (2015.1 to 2016.12) at Chiayi Chang Gung Memorial Hospital. We only considered patients who met the criteria of acute renal injury according to the Acute Kidney Injury Network (AKIN) and were undergoing mechanical ventilator support due to acute respiratory failure at admission. Results: Data showed that the overall ICU and hospital mortality rate was 63.5%. The most common cause of ICU admission in this cohort study was cardiovascular disease (31.7%) followed by respiratory disease (28.6%). Most patients (73%) suffered sepsis during their ICU admission and the mean length of hospital stay was 24.32 ± 25.73 days. In general, the factors independently associated with in-hospital mortality were lactate > 51.8 mg/dL, MAP ≤ 77.16 mmHg, and pH ≤ 7.22. The risk of in-patient mortality was analyzed using a multivariable Cox regression survival model. Adjusting for other covariates, MAP ≤ 77.16 mmHg was associated with higher probability of in-hospital death [OR = 3.06 (1.374–6.853), p = 0.006]. The other independent outcome predictor of mortality was pH ≤ 7.22 [OR = 2.40 (1.122–5.147), p = 0.024]. Kaplan-Meier survival curves were calculated and the log rank statistic was highly significant. Conclusions: Acute kidney injury combined with respiratory failure is associated with high mortality. High mean arterial pressure and normal blood pH might improve these outcomes. Therefore, the acid–base status and MAP should be considered when attempting to predict outcome. Moreover, the blood pressure targets for acute kidney injury in critical care should not be similar to those recommended for the general population and might prevent mortality.

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Section: Discussionsupporting

confidence: 67%

Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study

Lan

Chen

et al. 2021

Medicina

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“…Divisione di Nefrologia, Ospedale San Bortolo -Vicenza O I decorso dell' insufficienza renale ac uta (IR A) trattata con emodialisi gioma liera od intermittente e generalmente favorevole, e presenta una elevata percentu ale di ripresa funzional e. Tutt avia, nei pazienti in tera pia inten siva I'IRA viene frequ ent em ente complicata da patologie concomitanti e disfun zioni mul tio rgani ch e , c he co m po rta no un a prognosi piu severa e posson o rappresentare ulteri ori fatto ri di rischio 0 controindi cazion i al trattamento dialitico extracorporeo 0 per itoneale (2)(3)(4). A llo sco po d i superare tali pr obl em i, Kramer e Co il.…”

Section: Milan C Roncounclassified

Emofiltrazione Arterovenosa Continua E Tecniche Derivate

Milan¹,

Ronco²

1994

G Clin Nefrol Dial

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Prognostic Stratification in Critically Ill Patients With Acute Renal Failure Requiring Dialysis

Chertow¹

1995

Arch Intern Med

349

179

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Among critically ill patients, acute renal failure requiring dialysis is an ominous condition with a high risk of in-hospital mortality. This risk appears to depend largely on comorbid conditions, such as the need for mechanical ventilation and underlying malignancy. While this prognostic model requires prospective validation, it appears to identify a substantial fraction of patients for whom dialysis may be of limited or no benefit.

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Risk Factors Influencing Survival in Acute Renal Failure Treated by Hemodialysis

Cited by 91 publications

References 16 publications

Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study

Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study

Emofiltrazione Arterovenosa Continua E Tecniche Derivate

Prognostic Stratification in Critically Ill Patients With Acute Renal Failure Requiring Dialysis

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