Prognosis of patients with acute renal failure requiring dialysis: Results of a multicenter study (original) (raw)
Related papers
Renal Failure, 2002
Objective: Acute physiology, age, chronic health evaluation II and III (APACHE II and III) scoring systems obtained on the day of the initiation of dialysis were compared the mortality rate among in critically ill patients with acute renal failure requiring dialysis. Design: Retrospective study. Setting: Intensive care units in a tertiary care university hospital in Taiwan. Patients: 100 patients diagnosed with acute renal failure and requiring dialysis were admitted to intensive care units from January 1997 through December 1998. Interventions: Information deemed necessary to compute the APACHE II and APACHE III score on the day of dialysis initiation was collected. Measurements and results: The overall hospital mortality rate was 71%. The relationship between APACHE II and APACHE III scores for patients was linear and correlated significantly in all subgroups. Goodness-of-fit was good for 285 RENAL FAILURE, 24(3), 285-296 APACHE II and APACHE III models. Both reported good areas under receiver operating characteristic curve. Death in most patients was related to a higher APACHE II or APACHE III score during the 24 h immediately preceding the initiation of acute hemodialysis. Our results indicated a significant rise in mortality rates associated with higher APACHE II or III scores among all patients. Although less than 60%, the mortality rates markedly increased extent when APACHE II score of 24 or higher or APACHE III score above 90 had mortality rates exceeding 85%. Conclusion: Both predictive models demonstrated a similar degree of overall goodness-of-fit. Although APACHE II showed better calibration, APACHE III was better in terms of discrimination. The prediction accuracy of the APACHE II score for extremely high-risk patients is further enhanced by specific utility of APACHE III scoring as a second prediction model when the AII score is 24 or higher.
Dialysis outcomes as a measure of adequacy of dialysis
Seminars in Nephrology, 2005
Truly adequate dialysis would restore patients to full health, with functional status and length of life indistinguishable from others of the same age, sex, and race without chronic kidney disease. We are far from achieving such outcomes, however, in part because of the dearth of available evidence on which areas of care should be emphasized to get the greatest clinical and psychosocial benefits at the most affordable costs. A clear understanding of the strengths and limitations of currently available evidence can help guide researchers and clinicians in this field, and likely will lead to increasing emphasis on identification and management of comorbid conditions and a focus on preventative medicine. Optimal dialysis will be accomplished only when normal kidney functions are mimicked by artificial devices to a much greater extent than is currently the case. Semin Nephrol 25:70-75
Dialyzer membrane permeability and survival in hemodialysis patients
American journal of …, 2005
the French Study Group for Nutrition in Dialysis • Background: We previously showed that nutritional protein concentrations were predictive of outcome, whereas variables reflecting body composition and dialysis dose were not, in a 30-month prospective follow-up of 1,610 hemodialysis patients. Information on dialysis membrane and erythropoietin use had to be evaluated in an additional follow-up. Methods: A subset of 650 patients from the initial cohort of 1,610 was analyzed for survival in a 2-year extension of follow-up. Detailed data were collected: demographics; cause of renal failure; time on dialysis therapy; type of membrane; erythropoietin treatment; body mass index (BMI); predialysis albumin, prealbumin, and bicarbonate levels; and outcome. Normalized protein catabolic rate (nPCR), dialysis adequacy, and lean body mass were computed from predialysis and postdialysis urea and creatinine values. Results: Patient characteristics were age of 61 ؎ 16 years, 58% men, BMI of 22.7 ؎ 4.4 kg/m 2 , time on dialysis therapy of 102 ؎ 73 months, and 8.8% had diabetes. Dialysis parameters were duration of 247 ؎ 31 minutes, Kt/V of 1.4 ؎ 0.3, and nPCR of 1.2 ؎ 0.3 g/kg/d. Albumin level was 3.73 ؎ 0.53 g/dL (37.3 ؎ 5.3 g/L), and prealbumin level was 31 ؎ 8 mg/dL. The survival rate was 78.7% after 2 years. Survival was influenced by age, presence of diabetes, use of high-flux membrane, and serum albumin level, but not other variables, including Kt/V and prealbumin level. Two-year variations in values for urea, creatinine, and weight were predictive of survival in univariate, but not multivariate, analyses. Conclusion: In patients on dialysis therapy for a long period, better survival was observed when high-flux dialysis membranes were used. Am J Kidney Dis 45:565-571.
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2016
♦ Background and objective: Residual renal function (RRF) correlates with mortality and morbidity rates in patients receiving peritoneal dialysis (PD). We examined the effect of a biocompatible PD solution (Gambrosol Trio; Gambro Lundia AB, Lund, Sweden) with lower concentrations of glucose degradation products on rates of decline in RRF. ♦ Design, setting, participants, and measurements: Incident patients at 2 centers in Canada and 1 in Hong Kong were randomized (by minimization) in an open-label parallel group trial to receive Gambrosol Trio or standard PD solution (Dianeal; Baxter Healthcare, Mississauga, Canada) for 2 years. Primary outcome was slope of RRF. Secondary outcomes were urine volumes, fluid and nutrition indices, PD and membrane characteristics, peritonitis rates, adverse events, and PD technique survival. ♦ Results: Residual renal function declined by 0.132 mL/minute/1.73 m(2)/month in 51 patients allocated to biocompatible, and 0.174 mL/minute/1.73 m(2)/month in 50...
Renal Failure, 2001
Despite the widespread availability of dialytic and intensive care unit technology, the probability of early mortality in critically ill patients with acute renal failure (ARF) is still high, and the evaluation of the patients' prognosis has been difficult. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is a reliable indicator of severity of illness and likelihood of survival in critically ill patients with ARF. We have attempted to determine whether the APACHE II scoring system can be used to predict prognosis. Methods: A retrospective cohort study evaluated the medical records of 100 consecutive patients in intensive care units with acute renal failure who required dialysis from January 1997 through December 1998. Results: Of the 100 patients studied, 65 were men and 35 were women. The mean age of survivors and nonsurvivors was 59.4 ± 20.3 years and 58.3 ± 20.0 years. The overall mortality rate was 71%. There were no significant differences between survivors and nonsurvivors in age, gender, or indication for dialysis. The cause of death in the majority of patients was related to higher APACHE II score during the 24 hours immediately preceding the initiation of acute hemodialysis, and carry mortality rates exceeding 85% with an APACHE II score of 24 or higher.
Artificial Organs, 2007
Dialysis adequacy indices that are applied for the evaluation of the efficiency of urea removal include fractional water volume cleared from urea during dialysis (KT T/V), fractional solute removal (FSR), and equivalent urea clearance (EKR). Using a constant-volume, onecompartment urea kinetic model for an anuric patient, the FSR and EKR are shown to depend on only three nondimensional parameters: (i) KT/V, where K is the dialyzer clearance for hemodialysis (HD) or peritoneal mass transport coefficient for peritoneal dialysis (PD), T is the time period of dialysis, and V is urea distribution volume; (ii) T/Tc, where Tc is the length of treatment cycle; and (iii) VD/V, where VD is the volume of dialysis fluid applied. In particular, analytical formulas for FSR and EKR, valid for HD as well as for PD, were derived as functions of these three parameters. Numerical simulations, performed using a two-compartment urea kinetic model, showed that the analytical formulas are valid also for the two-compartment model, except for short, highly effective HD, where the overestimation of FSR and EKR using the analytical formulas is however, not higher than 20 and 16%, respectively. KT T/V is equal to KT/V for HD and FSR for PD. Thus, our formulas provide an integrative description of the relationships between dialysis efficiency indices and operational dialysis parameters that is valid for all modalities and schedules of dialysis. They may be applied not only for standard HD and continuous ambulatory PD, but also for HD with circulating dialysis fluid or intermittent forms of PD.
Nephrology Dialysis Transplantation, 2005
Background. Residual renal function (RRF) is an important predictor of outcome in peritoneal dialysis (PD) patients. Whether results from survival studies in dialysis patients with RRF can also be extrapolated to anuric patients remains uncertain. In this observational study, we examined the characteristics of PD patients with a residual glomerular filtration rate (GFR) !1 ml/min per 1.73 m 2 vs those with complete anuria and differentiated factors that predict outcome in the two groups of patients. Methods. Two hundred and forty-six continuous ambulatory peritoneal dialysis (CAPD) patients (39% being completely anuric) were recruited from a single regional dialysis centre. Assessments of haemodynamic, echocardiographic, nutritional and biochemical parameters and indices of dialysis adequacy were done at study baseline and were related to outcomes. Results. During the prospective follow-up of 30.8±13.8 (mean±SD) months, 28.0% of patients with residual GFR !1 ml/min per 1.73 m 2 vs 50.5% of anuric patients had died (P ¼ 0.005). The overall 2 year patient survival was 89.7 and 65.0% for patients with GFR !1 ml/min per 1.73 m 2 and anuric patients, respectively (P ¼ 0.0012). Compared with patients with GFR !1 ml/min per 1.73 m 2 , anuric patients were dialysed for longer (P<0.001), were more anaemic (P<0.005), and had higher calcium-phosphorus product (P<0.01), higher C-reactive protein (P<0.001), lower serum albumin (P<0.05), greater prevalence of malnutrition according to subjective global assessment (P<0.05) and more severe cardiac hypertrophy (P<0.001) at baseline. Using multivariable Cox regression analysis, serum albumin, left ventricular mass index and residual GFR were significant factors associated with mortality in patients with GFR !1 ml/ min per 1.73 m 2 , while increasing age, atherosclerotic vascular disease and higher C-reactive protein were associated with greater mortality in anuric PD patients. Conclusions. Our study demonstrates more adverse cardiovascular, inflammatory, nutritional and metabolic profiles as well as higher mortality in anuric PD patients. Furthermore, factors associated with mortality are also not equivalent for PD patients with and without RRF, suggesting that patients with and without RRF are qualitatively different. all rights reserved by guest on December 3, 2015 http://ndt.oxfordjournals.org/ Downloaded from Peritoneal dialysis in anuric ESRD patients 397 by guest on December 3, 2015 http://ndt.oxfordjournals.org/ Downloaded from PVD ¼ peripheral vascular disease; HD ¼ haemodialysis; CAPD ¼ continuous ambulatory peritoneal dialysis. a P<0.05, patients with GFR !1 ml/min per 1.73 m 2 vs anuric patients. 400 A.Y.-M. Wang et al. by guest on December 3, 2015