ACUTE-RENAL-FAILURE IN KUWAIT - A PROSPECTIVE-STUDY

This prospective study was conducted over a period of 18 months (Febru ary 1989 to July 1990) in the State of Kuwait. It covered a population of 1 024 211 and eight multidisciplinary hospitals with an in-patient admission of 118 079 per year. Two hundred and twenty-six adult patie nts with acute renal failure (ARF) were seen and followed up by nephro logists. This made the calculated annual incidence of ARF 14.7 per 100 000 population, nearly five times that reported by the EDTA registry (Biesenbach et al. 1991). Drugs, sepsis and volume depletion were the most frequent causes, with sepsis resulting in 36% cause specific mort ality compared to zero mortality with the other two. The overall morta lity rate was only 14% which clearly indicated a markedly improved pro gnosis in cases of ARF. The prognosis in ARF depended on two major fac tors, viz. the type of aetiological insult and the presence of predisp osing associated medical illnesses. Multiple insults, though common, d o not affect the mortality rate. Secondary sepsis or gastrointestinal bleeding as a cause of death in ARF was rarely seen in our study. Thos e who required dialytic support for renal failure had a 45 % patient m ortality rate in general. Over 40 % of our patients were 60 years or o lder compared with only 3.5 % in the local population. This indicated old age as a major risk factor in the development of ARF. The overall mortality in the elderly did not differ from that in the young, but se psis in the elderly carried a mortality rate of 60% compared to only 1 4.8% in the younger age group.