THE SPECTRUM OF ACUTE-RENAL-FAILURE IN THE INTENSIVE-CARE UNIT COMPARED WITH THAT SEEN IN OTHER SETTINGS

Acute renal failure (ARF) is at a crossroads between nephrology and in tensive care medicine. However, there seems to be wide differences bet ween the ARF observed in the intensive care unit (ICU) compared to tha t observed in other areas of the hospital, particularly when examining the mortality rate. Among the ICU patients the 70% mortality rate [1- 14] is higher to the 50% found in an overall series of studies [15-22] . Recently, Druml [23] proposed that there is a changing trend in the clinical spectrum of ARF as a convincing reason to justify these diffe rences. According to him, we are moving from an ARF seen as a mono-org an failure to another one observed in a multiorgan dysfunction syndrom e (MODS) contest [23]. Although extremely coherent, this hypothesis ha s not bren fully confirmed in a prospective study. In fact, most autho rs seem to look at the problem from opposite sides df the rivet, eithe r from the critical medicine or the nephrological bank. To the best of our knowledge, only one retrospective study has dealt with this topic [24] by comparing outcome of ARF in ICU and non-ICU patients. In this article we aim to overcome this problem by reviewing the data of the prospective epidemiological ARF study carried out in Madrid [25] using two different approaches: (I) comparing the ARF cases observed in the ICU setting with those ARF studied outside the ICU, and (2) comparing the outcome of isolated ARF with the outcome of ARF as part of a MODS in patients treated in both settings.