Dr WU Hiu Lam, Helen, Pamela Youde Nethersole Eastern Hospital, November 2008
Background: Renal replacement therapy (RRT), including haemodialysis (HD), haemofiltration (HF) and haemodiafiltration (HDF), either continuous or intermittent, is a common treatment modality in the Intensive Care Unit (ICU) for acute renal failure (ARF). Most studies of RRT among critically ill patients focused on short-term outcomes only. The aim of the present study was to investigate both the short- and long-term outcomes and prognostic factors of ARF patients requiring RRT in our Intensive Care Unit.
Methods: It was a retrospective observational study of ARF patients who had received RRT from January 2005 to December 2006 in the 20-bed ICU in Pamela Youde Nethersole Eastern Hospital. Record review of all patients and a questionnaire survey for hospital survivors were performed. The primary outcome was hospital mortality. Secondary outcomes were: dialysis dependency at hospital discharge, ICU and hospital length of stay, long term outcomes and quality of life of hospital survivors. Relationship between demographics, premorbidities and clinical parameters with primary outcome was studied.
Results: One hundred and thirty-five patients were included in the final analysis. Hospital mortality rate was 63.7%. The median survival was 24 days (IQR 7 to 746 days). Mechanical ventilation (HR 2.96, 95% CI 2.04 to 3.89) and hepatorenal syndrome (HR 2.29, 95% CI 1.63 to 2.95) were independently associated with hospital mortality. Dialysis dependency rate after hospital discharge as on day 60 was 4.1%. The 30-day, 60-day, 90-day and 1-year mortality rates from ICU admission were 56.3%, 61.5%, 64.4% and 68.1% respectively. For those who survived, their long term quality of life was better than similar studies in published literature.
Conclusion: ARF in ICU was associated with a high mortality rate which was correlated with hepatorenal syndrome and mechanical ventilation. Most of the hospital survivors were free from dialysis and their long term quality of life was better than similar studies in published literature. However, studies concerning long term outcomes among ARF patients was scarce, assessment tools were not standardized and the results were often expressed in different format making comparison and drawing meaningful conclusion difficult.
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