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South African Medical Journal

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Acute renal failure in the medical ICU still predictive of high mortality

DV Friedericksen, L van der Merwe, TL Hattingh, DG Nel, MR Moosa

Abstract


Background. We aimed to determine the outcome and certain
predictors of outcome for acute renal failure (ARF) in the medical intensive care unit (ICU) at Tygerberg Hospital.
Method. We conducted a retrospective, single-centre cohort
study over 12 months comprising all patients admitted to the
medical ICU with all causes of renal failure or who developed renal failure following admission to the ICU.
Results. Of 198 medical patients admitted to the ICU, ARF occurred in 46 (23.2%). The leading cause of ARF was acute tubular necrosis. The ICU mortality for ARF patients was 47.8%, compared with 17.5% in ICU patients without ARF. Acute haemodialysis was performed in only 17.3% of the 46 ARF patients. Using Cox proportional hazard regression, we found that mean duration of stay (p<0.001), acute physiology and chronic health evaluation II (Apache II) score (p<0.001), mechanical ventilation (p<0.01), dialysis (p<0.04) and multiorgan failure (p<0.05) affected survival time.
Conclusions. We found that ARF is still associated with a high mortality rate and longer duration of stay, higher Apache II score, and need for mechanical ventilation; dialysis and presence of multi-organ failure were indicators of a higher mortality rate.



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