PROGNOSIS OF ACUTE-RENAL-FAILURE IN THE ELDERLY

Life expectancy is uncertain in the elderly with ARF. In order to dete rmine whether a costly supportive management is worthwhile, we have st udied a group of 68 elderly patients (over 65 years of age) admitted t o the ICU with ARF. Patients: 47 male; 21 female; 72 +/- 6 years old. Types of ARF include prerenal 24; obstructive 9; intrinsic 35 (acute t ubular necrosis 30; glomerulonephritis 4; vascular 1). The mean simpli fied acute physiology score (SAPS) was 14 +/- 4; 39 patients (57.3%) h ad more than two underlying diseases; 42 patients (61.7%) were on mech anical ventilation; 40 patients (60%) underwent haemodialysis. The ove rall survival rate was 36.7%. Among the parameters studied, organic sy stemic failure index (OSF), diuresis, blood lactate, systolic blood pr essure, urea appearance rate (UAR), differed significantly in survivor s and deceased. From these results we conclude that the elderly with n on-oliguric ARF, normal blood lactate, low catabolic state, and no mor e than two organ failures have a fair chance of recovering and should therefore be treated aggressively. In other cases, decisions to procee d with intensive supportive measures should be made according to indiv idual characteristics.