Acute renal failure: death is common for patients on haemodialysis

Clinical bottom line (level 2b)

  1. Two thirds of patients with acute renal failure who require dialysis die before discharge.
  2. Patients are at increased risk of dying if they have
    • CNS depression after the first week
    • inotropic drug support after the first week
    • increasing age
Lien and Chan: Archives of Internal Medicine 1985; 145: 2067-2069
Expires October 2003

The study

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

Setting: acute hospital, Canada

58 patients (aged mean 61, 79% male) with acute renal failure treated by haemodialysis. Patients had haemodialysis of serum creatinine > 6.0 mg/dl, fluid overload or electrolyte distrubance.

Excluded if
  • known prior renal failure (serum creatinine > 2.5 mg/dl)



    • Factors studied:
  • age, sex, length of hospital stay, previous disease, cause of renal failure, oliguria, creatinine level, malnutrition




    • Multivariate regression analysis performed on prognostic factors.

    100% followed for more than 8 weeks
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death more than 8 weeks 37/58 64%
    (51% to 76%)

    • The following factors were independently associated with mortality
      • CNS depression after one week
      • inotropic drug support after one week
      • increasing age

    Comments

    1. No odds ratios were provided for the prognostic factors.

    Citation

    1. Lien J, and Chan V: Risk factors influencing survival in acute renal failure treated by hemodialysis. Archives of Internal Medicine 1985; 145: 2067-2069
    Search Terms: ?
    Contributor: Chris Ball, October 1999
    Reviewer:

    Clinical Question.
    Patient acute renal failure on haemodialysis
    Intervention or Exposure prognostic factors
    Outcome death