Acute renal failure (ARF) in Scotland occurs more frequently than previously thought, according to researchers.
Gordon J. Prescott, PhD, of the Royal Infirmary in Edinburgh, and his colleagues prospectively collected data on patients starting renal replacement therapy (RRT) for ARF at all hospitals in Scotland within three 12-week periods in 2002.
Over the 36 weeks, 809 patients started RRT for ARF, out of a Scottish population of five million, the researchers reported. This translates into age standardized incidence of 286 adults per million population (pmp) per year, the investigators reported in Nephrology Dialysis Transplantation (2007; published online ahead of print). Of these, 212 adults pmp had no evidence of pre-existing CKD (group A); the remaining 74 pmp had acute onset CKD (group B).
Previous estimates of the incidence of ARF requiring RRT ranged from about 22-110 pmp, the authors noted. The much higher estimate found in their study reflects the large study population and the ability to study all patients within it. Many previous studies had looked only at ARF within ICUs.
The patients had a mean age of 67 years. The incidence of ARF rose with age and pre-existing comorbid illness. Fifty-one percent of patients received their first RRT treatment in a critical care setting, and only 45% received their first RRT for ARF in a renal ward or unit. The etiology of ARF was multifactorial in almost half of cases, with sepsis a contributing factor in 48% of cases.
The data also showed that 83% of group A and 97% of group B had at least one comorbid illness at the time of first RRT. The most common comorbid illnesses were ischemic heart disease (27% of patients), chronic obstructive pulmonary disease (19%), and type 2 diabetes (18%). Forty-eight percent patients died within 90 days of starting RRT.