Acute renal failure: oliguria and sepsis as cause increased the risk of death.

Clinical bottom line (level 2b)

  1. Around 40% of patients with acute renal failure severe enough to require dialysis, died.
  2. Patients with acute renal failure who required dialysis were at an increased risk of dying if they had:
    • oliguria (NNF = 3 for months)
    • sepsis as the cause of renal failure (NNF = 2 for months)
Cantarovich et al: Renal Failure 1996; 18 (4): 585-589
Expires August 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 21 hospitals, France and Holland

94 patients (aged mean 58 years, 64% male) acute renal failure requiring dialysis after no response to a single dose of 15 mg/kg of furosemide i.v. (perfusion >6 hours)

Excluded if
  • functional, chronic (previous creatinine >150 mmol/d), or obstructive renal failure
  • vasculitis or glomerulitis
  • auditive impairment



    • Factors studied:
  • death
  • urine output <500 ml/day
  • sepsis as cause of renal failure




    • Multivariate regression analysis was performed to adjust for confounding factors.

    100% followed for until discharge
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death until discharge 39/94 41%
    (32% to 51%)

    prognostic factor for
    death     		time to outcome unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    urine output <500 ml/day until discharge 2.59
    (1.28 to 5.22)     		3
    (1 to 17)
    sepsis as cause of renal failure until discharge 3.25
    (1.97 to 5.34)     		2
    (1 to 4)

    Comments

    1. Data was taken from a randomised controlled trial.
    2. No adjusted odds ratios were given.

    Citation

    1. Cantarovich F, Verho MT, Participants of the French Multicentric Prospective Study on Furosemide in Acute Renal Failure Requiring Dialysis , et al: A simple prognostic index for patients with acute renal failure requiring dialysis. Renal Failure 1996; 18 (4): 585-589
    Search Terms: acute renal failure in Cochrane
    Contributor: Chris Ball and Clare Wotton, April 2000
    Reviewer: Mohammad Saklayen

    Clinical Question.
    Patient acute renal failure
    Intervention or Exposure prognostic factors
    Outcome mortality