Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension
Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies,☆☆

https://doi.org/10.1053/ajkd.2002.34505Get rights and content

Abstract

Background: Limited health care budgets have raised the issue of how much therapy should be dedicated to critically ill patients with multiorgan and acute renal failure (ARF). No data are available on patients with ARF after hospital discharge. Methods: We assessed long-term survival and quality of life after discharge. Nine hundred seventy-nine patients with ARF who needed continuous renal replacement therapies were analyzed retrospectively. Contact was achieved by questionnaires assessing health status and mental and physical well-being. Results: The in-hospital mortality rate was 69% (n = 678). Postdischarge information was obtained from 89% (n = 267). Kaplan-Meier analyses showed surprisingly good postdischarge survival. Discharged patients had a 77% probability to survive the first 6 months. Those who did so had a probability of 89% to survive the following 6 months. After 5 years, the survival probability was 50%. Age and more than one comorbidity before hospitalization were associated with significantly lower postdischarge survival. Seventy-seven percent of questionnaire responders assessed their current health status as good to excellent, 57% were self-sustaining, and 49% stated that their quality of life had improved. Renal insufficiency remained in 41%, whereas 10% required chronic dialysis therapy. Conclusion: ARF is associated with a high in-hospital mortality rate. Nevertheless, patients leaving the hospital had a reasonable survival rate and good quality of life. We conclude that aggressive intensive care unit treatment is justified in these patients. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Patients

The university hospital (Charité, Campus Mitte, Berlin, Germany) has 72 ICU beds serving general surgery, cardiac surgery, neurosurgery, orthopedics, neurology, cardiology, general internal medicine, and infectious diseases. Between January 1, 1993, and December 31, 1998, a total of 979 patients with ARF were treated with continuous renal replacement therapies in the various units. The diagnosis of ARF was based on one of the following criteria: (1) fluid overload owing to inadequate urine

Results

The in hospital mortality rate for the 979 patients with ARF was 69% (n = 678). Their clinical features are listed in Table 1.

. Demographic and Clinical Characteristics of Patients With ARF Who Needed Continuous Renal Replacement Therapy in the ICU

Empty CellNonsurvivorsSurvivorsP
No. of patients678301
Age (y)62.2 ± 2.758.5 ± 13.8NS
Sex (M/F)432/246207/94
APACHE II score21.9 ± 5.120.5 ± 5.0NS
CRRT duration (d)11.6 ± 13.817.3 ± 6.40.033
Etiology (%)
 Cardiac surgery40*44
 Noncardiac surgery19*32
 Internal

Discussion

To our knowledge, this is the first study to determine what happens to surviving patients with ARF after they leave the hospital. Although our in-hospital mortality was as dismal as that reported elsewhere, we found that subsequent survival was surprisingly good. Discharged patients had a 77% probability to survive the first 6 months. Those who made that goal had a probability of 89% to survive the following 6 months. After 5 years, the survival probability was 50%. We also observed a

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Address reprint requests to Stanislao Morgera, MD, Universitätsklinikum Charité der Humboldt Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Nephrologie am CCM, Schumannstr 20-21, 10098 Berlin, Germany. E-mail: [email protected]

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