ACUTE-RENAL-FAILURE IN A MEDICAL SETTING - CHANGING PATTERNS AND PROGNOSTIC FACTORS

The clinical characteristics of 118 patients (60 male) with acute rena l failure (ARF) admitted between 1980 and 1991, were retrospectively a nalyzed and compared with our earlier series of the 1960s. The mean ag e was 53 years (16-82 years). There was a marked decline in the hypote nsion-related cases (43% vs. 17%, p < 0.01) and a concomitant increase in the nephrotoxic cases (5% vs. 17%, p < 0.005) in recent years. The number of ARF cases significantly decreased after 1986 (31%) compared to the pre-1986 era (69%, p < 0.001). A complete (35%) or partial rec overy (55%) was the rule in the majority of the patients. The overall mortality was 27%, virtually unchanged in comparison to the 1960s (30% ). However, a tendency toward lower mortality was seen after 1986 (17% ) in comparison to before (32%, p < 0.05). Sepsis and cardiovascular c omplications were the leading causes of death. Fewer deaths were obser ved among younger patients (<30 years, 12.5%) compared to middle-aged patients (30-59 years, 34%, p < 0.05) and to these older than 60s (53. 5%, p < 0.002). Also, deaths were rare in patients with only renal inv olvement (6%), increasing to 30% when 2 vital organ systems were affec ted (p < 0.005) and to 67% in cases with multiple organ failure (p < 0 .001). Early institution of dialysis and the nonoliguric forms of the syndrome seem to be associated with better prognosis. In conclusion, t he incidence of ARF has declined in recent years, with a concomitant t endency towards lower mortality. Death rate is mainly determined by, t he age and the number of organ involvement. Early dialysis seems to co ntribute to the lower mortality seen in recent cases.-