One Year Cross Sectional Study of Etiology and Outcome of Hospital Acquired Acute Renal Falure

Abstract

Background and Objectives ABSTRACT Acute renal failure in the intensive care unit is a common condition in the hospitalized patients. Morbidity and mortality due to hospital acquired acute renal failure is high and varies from 19 to 59%. The present study was conducted to assess the etiology and outcome of the patients developing renal failure in the hospital ( hospital acquired acute renal failure ) in terms of mortality and morbidity, and to analyse causes, risks and prognostic factors, and final outcome of ARF in ICU setting. Methods The present one year cross sectional study was conducted in Department of Medicine on 65 patients admitted at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum during period of January 2008 to December 2008. Adult patients who developed renal failure ( Creatinine ≥ 1.5 mg/dL ) any time after 48 hours of admission were included in the study and were referred as HAARF. Patients who were having chronic kidney disease or who had acute renal failure on admission were excluded from study. Results The mean age of patients was 52.38±17.02 years, 87.69% were males. Comorbidity was seen in 69.23% ( Hypertension, diabetes, CAD ) . HAARF had developed complicating the medical ( 58.46% ) and surgical conditions ( 56.92% ) . Most common cause of HAARF was multifactorial etiology ( 70.77% ) and 53.85% sepsis. MOD was noted in 40% of cases. Altered sensorium ( 96.43% ) , X metabolic acidosis ( 92% ) , MOD ( 88.46% ) , requirement of ionotropic support ( 84.44% ) and mechanical ventilation ( 82.50% ) , oliguria ( 78.72% ) , hypotension ( 78.57% ) were independent risk factors associated with outcome of HAARF ( p<0.05) . Overall mortality of HAARF was 63.08% and 36.93% of patients had recovery of them, 33.85% patients had complete recovery and 3.08% had partial recovery and they were independent of dialysis. Conclusion The HAARF patients had the high mortality despite of aggressive modern treatment. Commonest precipitating factor was multifactorial etiology followed by sepsis.