Acute renal failure in an intensive care unit

OBJECTIVE: To determine the clincal course and outcome of acute renal failure in an intensive care unit set-up.

METHODS: All patients admitted to the intensive care until who developed acute renal failure were prospectively studied over a 3-year period from 1996 to 1999, at King Fahd Hospital of the University, Al Khobar, Kingdom of Saudi Arabia. They were investigated for the causes of their acute renal failure, given appropriate treatment and their course carefully documented until discharge from the intensive care unit.

RESULTS: Forty-seven patients (29 male and 18 female) were studied. The majority were Saudis (81%). The age range was 28-81 years with a mean of 53 ± 14 years. Renal causes, 31 cases (66%), were the most frequent causes of acute renal failure. Pre-renal causes occurred in 12 cases (25.5%) and post-renal causes in 4 cases (8.5%). Three quarters of the causes were medical and one quarter surgical. Septicemia (22 cases), dehydration with hypovolemia (8 cases) and myo/hemoglobinuria (5 cases) were the leading medical causes. Fifteen patients (32%) died in the intensive care unit while 32 were discharged (68%). Multiple organ dysfunction, disseminated intravascular coagulopathy, acute respiratory distress syndrome and diabetes mellitus were the major factors that adversely affected mortality. There was a statistically significant difference in the length of intensive care unit stay of the survivors (5.7±2.6 days) compared to the deceased (11±5.8 days) (P<0.005). Renal replacement therapy was performed in 15 patients (10 continuous veno-venous hemodialysis and 5 conventional hemodialysis). Almost 3 quarters (73%) of the deceased required renal replacement therapy.

CONCLUSION: The development of acute renal failure in the setting of an intensive care unit carried a poor prognosis. Renal causes are responsible for 2 in 3 cases. Septicemia, dehydration/hypovolemia, myo/hemoglobinuria are the leading medical causes while multiple organ dysfunction, disseminated intravascular coagulopathy, acute respiratory distress syndrome and diabetes mellitus increase mortality. The poor prognosis of patients developing acute renal failure in the intensive care unit can be improved if attention is paid to prevention of septicemia, dehydration, prompt and aggressive treatment of multiple organ dysfunction, disseminated intravascular coagulopathy, acute respiratory distress syndrome and diabetes mellitus.