Acute renal failure in critically ill patients: A multinational, multicenter study

Shigehiko Uchino, John A. Kellum, Rinaldo Bellomo, Gordon S. Doig, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Ettiene Macedo, Noel Gibney, Ashita Tolwani, Claudio Ronco

Research output: Contribution to journalArticle

2473 Citations (Scopus)

Abstract

Context: Although acute renal failure (ARF) is believed to be common in the setting of critical illness and is associated with a high risk of death, little is known about its epidemiology and outcome or how these vary in different regions of the world. Objectives: To determine the period prevalence of ARF in intensive care unit (ICU) patients in multiple countries; to characterize differences in etiology, illness severity, and clinical practice; and to determine the impact of these differences on patient outcomes. Design, Setting, and Patients: Prospective observational study of ICU patients who either were treated with renal replacement therapy (RRT) or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001 at 54 hospitals in 23 countries. Main Outcome Measures: Occurrence of ARF, factors contributing to etiology, illness severity, treatment, need for renal support after hospital discharge, and hospital mortality. Results: Of 29 269 critically ill patients admitted during the study period, 1738 (5.7%; 95% confidence interval [CI], 5.5%-6.0%) had ARF during their ICU stay, including 1260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5%; 95% CI, 45.2%-49.5%). Approximately 30% of patients had preadmission renal dysfunction. Overall hospital mortality was 60.3% (95% CI, 58.0%-62.6%). Dialysis dependence at hospital discharge was 13.8% (95% CI, 11.2%-16.3%) for survivors. Independent risk factors for hospital mortality included use of vasopressors (odds ratio [OR], 1.95; 95% CI, 1.50-2.55; P

Original languageEnglish
Pages (from-to)813-818
Number of pages6
JournalJournal of the American Medical Association
Volume294
Issue number7
DOIs
Publication statusPublished - Aug 17 2005
Externally publishedYes

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Acute Kidney Injury
Critical Illness
Multicenter Studies
Confidence Intervals
Hospital Mortality
Intensive Care Units
Renal Replacement Therapy
Kidney
Septic Shock
Observational Studies
Survivors
Dialysis
Epidemiology
Odds Ratio
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Acute renal failure in critically ill patients : A multinational, multicenter study. / Uchino, Shigehiko; Kellum, John A.; Bellomo, Rinaldo; Doig, Gordon S.; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Ronco, Claudio.

In: Journal of the American Medical Association, Vol. 294, No. 7, 17.08.2005, p. 813-818.

Research output: Contribution to journalArticle

Uchino, S, Kellum, JA, Bellomo, R, Doig, GS, Morimatsu, H, Morgera, S, Schetz, M, Tan, I, Bouman, C, Macedo, E, Gibney, N, Tolwani, A & Ronco, C 2005, 'Acute renal failure in critically ill patients: A multinational, multicenter study', Journal of the American Medical Association, vol. 294, no. 7, pp. 813-818. https://doi.org/10.1001/jama.294.7.813
Uchino, Shigehiko ; Kellum, John A. ; Bellomo, Rinaldo ; Doig, Gordon S. ; Morimatsu, Hiroshi ; Morgera, Stanislao ; Schetz, Miet ; Tan, Ian ; Bouman, Catherine ; Macedo, Ettiene ; Gibney, Noel ; Tolwani, Ashita ; Ronco, Claudio. / Acute renal failure in critically ill patients : A multinational, multicenter study. In: Journal of the American Medical Association. 2005 ; Vol. 294, No. 7. pp. 813-818.
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AU - Uchino, Shigehiko

AU - Kellum, John A.

AU - Bellomo, Rinaldo

AU - Doig, Gordon S.

AU - Morimatsu, Hiroshi

AU - Morgera, Stanislao

AU - Schetz, Miet

AU - Tan, Ian

AU - Bouman, Catherine

AU - Macedo, Ettiene

AU - Gibney, Noel

AU - Tolwani, Ashita

AU - Ronco, Claudio

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N2 - Context: Although acute renal failure (ARF) is believed to be common in the setting of critical illness and is associated with a high risk of death, little is known about its epidemiology and outcome or how these vary in different regions of the world. Objectives: To determine the period prevalence of ARF in intensive care unit (ICU) patients in multiple countries; to characterize differences in etiology, illness severity, and clinical practice; and to determine the impact of these differences on patient outcomes. Design, Setting, and Patients: Prospective observational study of ICU patients who either were treated with renal replacement therapy (RRT) or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001 at 54 hospitals in 23 countries. Main Outcome Measures: Occurrence of ARF, factors contributing to etiology, illness severity, treatment, need for renal support after hospital discharge, and hospital mortality. Results: Of 29 269 critically ill patients admitted during the study period, 1738 (5.7%; 95% confidence interval [CI], 5.5%-6.0%) had ARF during their ICU stay, including 1260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5%; 95% CI, 45.2%-49.5%). Approximately 30% of patients had preadmission renal dysfunction. Overall hospital mortality was 60.3% (95% CI, 58.0%-62.6%). Dialysis dependence at hospital discharge was 13.8% (95% CI, 11.2%-16.3%) for survivors. Independent risk factors for hospital mortality included use of vasopressors (odds ratio [OR], 1.95; 95% CI, 1.50-2.55; P

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