Objective: To elucidate the risk factors for the development of acute
renal failure (ARF) in severe trauma. Design: Prospective observationa
l study. Setting: A general intensive care unit (ICU) of a university
hospital. Patients: A cohort of 153 consecutive trauma patients admitt
ed to the ICU over a period of 30 months. Results: Forty-eight (31 %)
patients developed ARE They were older than the 105 patients without A
RF (p = 0.002), had a higher Injury Severity Score (ISS) (p < 0.001),
higher mortality (p < 0.001), a more compromised neurological conditio
n (p = 0.007), and their arterial pressure at study entry was lower (p
= 0.0015). In the univariate analysis, the risk of ARF increased by a
ge, ISS > 17, the presence of hemoperitoneum, shock, hypotension, or b
one fractures, rhabdomyolysis with creatine phosphokinase (CPK) > 10 0
00 IU/l, presence of acute lung injury requiring mechanical ventilatio
n, and Glasgow Coma Score < 10. Sepsis and use of nephrotoxic agents w
ere not associated with an increased risk of ARE In the logistic model
, the need for mechanical ventilation with a positive end-expiratory p
ressure > 6 cm H2O, rhabdomyolysis with CPK > 10 000 IU/l: and hemoper
itoneum were the three conditions most strongly associated with ARF.Co
nclusions: The identified risk factors for post-traumatic acute renal
failure may help the provision of future strategies.