Epidemiology

Sepsis the leading cause of acute renal failure in the ICU

Last Updated: 2005-08-17 15:33:02 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In ICUs around the world, approximately 6% of patients develop acute rental failure (ARF), with close to two-thirds of them receiving renal replacement therapy, results of a multinational observational study suggest. Mortality rates among these patients are high, and approximately half of cases are associated with septic shock.

Most epidemiologic studies of ARF in critically ill patients are confined to single countries, and all have been conducted in Australia, Europe, or North America, Dr. John A. Kellum and colleagues note in their report, published in the Journal of the American Medical Association for August 17.

To obtain a more global view of the problem, Dr. Kellum, from the University of Pittsburgh in Pennsylvania, and his associates surveyed ICUs at 54 centers in 23 countries in Europe, North and South America, Asia and Australia. The data included nearly 30,000 critically ill patients admitted from September 2000 to December 2001.

The investigators found that 1738 patients (5.7%) developed ARF during their ICU stay, with prevalence ranging from 1.4% to 25.9% across all study centers.

The most common factor contributing to ARF was septic shock, followed by major surgery, cardiogenic shock, and hypovolemia. Fewer than 20% of cases were drug induced or related to hepatorenal syndrome or obstructive uropathy.

The overall hospital mortality in these cases was 60.3%. Of patients who survived to hospital discharge, 13.8% still required renal replacement therapy.

"In the final (multivariate regression) model," Dr. Kellum's group notes, "important risk factors for outcome included vasopressors, mechanical ventilation, sepsis/septic shock, cardiogenic shock, hepatorenal syndrome, diagnostic grouping, type of ICU, and number of beds per ICU."

"This information may be helpful in the design of future international interventional trials, which would apply to worldwide practice, in regard to the statistical power and choice of appropriate outcome measures," the authors conclude.

JAMA 2005;294:813-818.