Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care

Abstract.

Objective: To assess (1) the long-term outcome of patients requiring renal replacement therapy (RRT) in terms of 6-month and 5-year mortality, (2) quality of life and (3) costs of the intensive care. Design: A retrospective observational cohort study. Setting: Twenty-three-bed multidisciplinary intensive care unit (ICU) in a tertiary care center. Patients and participants: Out of 3447 intensive care patients admitted, 62 patients with no end-stage renal failure required RRT. Interventions: None. Measurements and results: The incidence rate of acute renal failure (ARF) was 8/100,000 inhabitants/year. The majority of patients (71%) had ARF in conjunction with multiple organ failure. The mortality in the ICU and in the hospital was 34% and 45%, respectively. Mortality was 55% at 6 months and 65% at 5 years. Renal function recovered in 82% of the survivors during hospitalization. Loss of energy and limitations of physical mobility assessed by Nottingham Health Profile were the most frequently reported complaints at 6 months. Functional ability, as assessed by the Activities of Daily Living score was fairly good at 6 months. The cost per ARF 6-month survivor was $80 000. Conclusions: There was only a minor increase in mortality after discharge from hospital among patients treated for ARF in intensive care. The costs related to ARF in intensive care are high, but the almost complete physical and functional recovery seen in ARF survivors should be noted in cost-effective analyses.