EPIDEMIOLOGY OF ACUTE-RENAL-FAILURE AND OUTCOME OF HEMODIAFILTRATION IN INTENSIVE-CARE

Objective: To examine the epidemiology of acute renal failure (ARF) an d to identify predictors of mortality in patients treated by continuou s venovenous haemodiafiltration (CVVHDF). Design: Uncontrolled observa tional study. Setting: One intensive care unit (ICU) at a surgical and trauma centre. Patients: A consecutive sample of 3591 ICU treatments. Measurements and results: Demographic data, indications for ICU admis sion, severity scores and organ system failure at the beginning of CVV HDF were set against the occurrence of ARF and ICU mortality. 154 (4.3 % of ICU patients and 0.6% of the hospital population) developed ARF a nd were treated with CVVHDF. Higher American Society of Anesthesiologi sts (ASA) status and higher Apache II score were associated with ICU i ncidence of ARE However. these criteria were not able to predict outco me in ARE A simplified predictive model was derived using multivariate logistic regression modelling. The mortality rates were 12% with one failing organ system (OSF), 38% with two OSF, 72% with three OSF, 90% with four OSF and 100% with five OSF The adjusted odds ratio (OR) of d eath was 7.7 for cardiovascular failure, 6.3 for hepatic failure. 3.6 for respiratory failure, 3.0 for neurologic failure, 5.3 for massive t ransfusion and 3.7 for age of 60 years or more. Conclusion: General me asures of severity are not useful in predicting the outcome of ARE Onl y the nature and number of dysfunctioning organ systems and massive tr ansfusion at the beginning of CVVHDF and the age of the patients gave a reliable prognosis in this group of patients.