Christian, Jose Pedro Cidade, Barbara Wanjiru Citarella, Christl A. Barrett, Abigail Beane, Aidan Burrell, Matthew Pellan Cheng, Michael D. Docherty, Christiana Kartsonaki, Irene Aragao, Peter W. Improved methods to estimate baseline SCr are needed.Luis Felipe Reyes, Srinivas Murthy, Esteban Garcia-Gallo, Mike Irvine, Laura Merson, Ignacio Martin-Loeches, Jordi Rello, Fabio S. However, in patients with suspected CKD, the use of MDRD to estimate baseline SCr overestimates the incidence of AKI and should not likely be used. While limited, estimating baseline SCr by the MDRD equation when pre-morbid SCr is unavailable would appear to perform reasonably well for determining theRIFLE categories only if andwhen pre-morbidGFRwas near normal. Exclusion of CKD patients improved the correlation between oSCr and eSCr at ICU admission and study enrolment (r = 0.90, r = 0.84) resulting in 6.6% and 4.0% being misclassified, respectively. At ICU admission and study enrolment, eSCr misclassified 18.8% and 11.7% of patients as having AKI compared with oSCr. The oSCr and eSCr determined at ICU admission and at study enrolment showed only a modest correlation (r = 0.49, r = 0.39). The median (IQR) values were 97 μmol/L (79–150) for oSCr and 88 μmol/L (71–97) for eSCr. Seventy-six percent of patients (n = 1327) had a pre-morbid baseline SCr, and 1314 had complete data for evaluation. Sensitivity analysis by chronic kidney disease (CKD) status was performed. Agreement was evaluated by correlation coefficients and Bland–Altman plots. The RIFLE classwas determined by using observed (o) pre-morbid and estimated (e) baseline SCr values.
Data from the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study, a prospective observational study from 54 ICUs in 23 countries of critically ill patients with severe AKI, were analysed. However, the MDRD approach assumes a glomerular filtration rate of ∼75 mL/min/1.73 m2. When unknown, current recommendations are to estimate a baseline SCr by the MDRD equation. The SCr criteria, therefore, require a pre-morbid baseline value. The RIFLE classification scheme for acute kidney injury (AKI) is based on relative changes in serum creatinine (SCr) and on urine output. CONCLUSIONS: There are significant risk factors for death among patients with acute renal failure in intensive care units, which need to be identified at an early stage for early treatment.Ībstract Background. From multivariate analysis, the independent risk factors for death were: need for mechanical ventilation (OR = 3.15 p = 0.03), hypotension (OR = 3.48 p = 0.02), liver failure (OR = 5.37 p = 0.02), low arterial bicarbonate (OR = 0.85 p = 0.005), oliguria (OR = 3.36 p = 0.009), vasopressor use (OR = 4.83 p = 0.004) and sepsis (OR = 6.14 p = 0.003). There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. The risk factors most frequently associated with death were hypotension, sepsis, nephrotoxic drug use, respiratory insufficiency, liver failure, hypovolemia, septic shock, multiple organ dysfunction, need for vasoactive drugs, need for mechanical ventilation, oliguria, hypoalbuminemia, metabolic acidosis and anemia. RESULTS: Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 ± 20 years (79 males 62%). Univariate and multivariate analyses were performed to establish risk factors for death. METHODS: Survivors and non-survivors were compared. DESIGN AND SETTING: Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure. CONTEXT AND OBJECTIVE: Acute renal failure is a common medical problem, with a high mortality rate.
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