Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia

Objective. To study the epidemiology, style of management, and outcome of i ntensive care patients with acute renal failure requiring replacement thera py in Australia. Design. Prospective epidemiologic study. Setting. Australian adult intensive care units providing acute renal replac ement therapy. Patients. Adult intensive care patients with acute renal failure treated wi th renal replacement therapy. Interventions. Demographic and clinical data collection for 3 months. Measurements and Main Results. A standardized data collection form for each case of severe acute renal failure was used to collect demographic, bioche mical, clinical, and outcome data. Severe acute renal failure affected 299 patients (approximately eight cases per 100,000 adults per year). Among the se patients, 99 (33.1%) had impaired baseline renal function, 238 (79.6%) n eeded mechanical ventilation, and 232 (77.6%) needed continuous vasoactive drug administration. Critical care physicians controlled patient care and r enal replacement therapy in 289 cases (96.7%). Critical care nurses perform ed such therapy alone in 288 (96.3%) cases. Continuous renal replacement th erapy was used in 292 (97.7%) patients. There was no nephrological input in 173 (57.8%) cases. Predicted mortality rates were 52.1% by Simplified Acut e Physiology Score II, 49.5% by Acute Physiology and Chronic Health Evaluat ion II score, and 51.9% by an acute renal failure-specific score. Actual mo rtality rate was 46.8%. Only 25 (15.7%) patients were dialysis-dependent at hospital discharge. Of these patients, 20 (80%) had premorbid chronic impa irment of renal function. Conclusion: In Australia, critical care physicians and nurses manage severe acute renal failure with limited consultative nephrological input. Renal r eplacement therapy is continuous and outcomes are satisfactory. Our finding s support the view that this approach to management of severe acute renal f ailure is safe.