Abstract
Periodically the question is posed “Why the persistently high mortality in acute renal failure?”. By 1986, little progress seemed to have been made in improving outcome and it was stated that once oliguria was resistant to volume replacement and cardiac support, the patient had at best only a 50% chance of surviving. During the period 1960–1985, it can be shown that although outcome was not improving, older and sicker patients were being treated. Reviewing the literature of the past decade, the age and case mix of patients appears stable, but there is no suggestion of improvement in outcome. ARF with sepsis continues to have a mortality of 65 to 80%, and the outcome remains poor in elderly patients with failure of two or more organs. Progress has been slow in Intensive Care Units, and the past 20 years has seen little more than a move away from parenteral towards enteral feeding. Recent advances, however, in ventilatory techniques and the use of supra-physiological doses of glucocorticoids may lead to some improvement in outcome.
Article PDF
Similar content being viewed by others
References
Cameron JS. Acute renal failure - the continuing challenge. Q J Med 1986; 59: 337–343.
Liano F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996; 50: 811–818.
Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units-causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 1996; 24: 192–198.
Khan IH, Catto GR, Edward N, Macleod AM. Acute renal failure: factors influencing nephrology referral and outcome. QJM 1997; 90: 781–785.
Feest TG, Round A, Hamad S. Incidence of severe acute renal failure in adults: results of a community based study. Br Med J 1993; 306: 481–483.
Turney JH, Marshall DH, Brownjohn AM, Ellis CM, Parsons FM. The evolution of acute renal failure, 1956-1988. Q J Med 1990; 74: 83–104.
Bellomo R, Farmer M, Boyce N. The outcome of critically ill elderly patients with severe acute renal failure treated by continuous hemodiafiltration. Int J Artif Organs 1994; 17: 466–472.
Klouche K, Cristol JP, Kaaki M, Turc BC, Canaud B, Beraud JJ. Prognosis of acute renal failure in the elderly. Nephrol Dial Transplant 1995; 10: 2240–2243.
Alarabi A, Nystrom SO, Stahle E, Wikstrom B. Acute renal failure and outcome of continuous arteriovenous hemodialysis (CAVHD) and continuous hemofiltration (CAVH) in elderly patients following cardiovascular surgery. Geriatr Nephrol Urol 1997; 7: 45–49.
Maziak DE, Lindsay TF, Marshall JC, Walker PM. The impact of multiple organ dysfunction on mortality following ruptured abdominal aortic aneurysm repair. Ann Vasc Surg 1998; 12: 93–100.
Bihari DJ. The prevention of severe combined acute respiratory and renal failure in the intensive therapy unit. In: Bihari D, Neild GH, eds. Acute renal failure in the Intensive Therapy Unit, 1 ed. London: Springer-Verlag, 1989: 359–385.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818–829.
Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100: 1619–1636.
Pascual J, Liano F, Ortuno J. The elderly patient with acute renal failure. J Am Soc Nephrol 1995; 6: 144–153.
Macias JF. Acute renal failure in old age. In: Bihari D, Neild GH, eds. Acute renal failure in the Intensive Therapy Unit, 1 ed. London: Springer-Verlag, 1989: pp. 41–44.
Stott RB, Cameron JS, Ogg CS, Bewick M. Why the persistently high mortality in acute renal failure. Lancet 1972; 2: 75–79.
Turney JH. Why is mortality persistently high in acute renal failure? Lancet 1990; 335: 971.
McCarthy JT. Prognosis of patients with acute renal failure in the intensive-care unit: a tale of two eras. Mayo Clin Proc 1996; 71: 117–126.
Woodrow G, Turney JH. Cause of death in acute renal failure. Nephrol Dial Transplant 1992; 7: 230–234.
Neveu H, Kleinknecht D, Brivet F, Loirat P, Landais P. Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. The French Study Group on Acute Renal Failure. Nephrol Dial Transplant 1996; 11: 293–299.
Gopal I, Bhonagiri S, Ronco C, Bellomo R. Out of hospital outcome and quality of life in survivors of combined acute multiple organ and renal failure treated with continuous venovenous hemofiltration/hemodiafiltration. Intensive Care Med 1997; 23: 766–772.
Lameire N, Matthys E, Vanholder R, et al. Causes and prognosis of acute renal failure in elderly patients. Nephrol Dial Transplant 1987; 2: 316–322.
Estafanous FG, Loop FD, Higgins TL, et al. Increased risk and decreased morbidity of coronary artery bypass grafting between 1986 and 1994. Ann Thorac Surg 1998; 65: 383–389.
Van Den Noortgate N, Vogelaers D, Afschrift M, Colardyn F. Intensive care for very elderly patients: outcome and risk factors for in-hospital mortality. Age Ageing 1999; 28: 253–256.
Kass JE, Castriotta RJ, Malakoff F. Intensive care unit outcome in the very elderly. Crit Care Med 1992; 20: 1666–1671.
Castillo LE, Rivera FR, Vazquez MG. Limitation of therapeutic activity in elderly critically ill patients. Project for the Epidemiological Analysis of Critical Care Patients. Crit Care Med 1997; 25: 1643–1648.
Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998; 338: 347–354.
Dellinger RP, Zimmerman JL, Taylor RW, et al. Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group. Crit Care Med 1998; 26: 15–23.
Meduri GU, Headley AS, Golden E, et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 1998; 280: 159–165.
Heyland DK, MacDonald S, Keefe L, Drover JW. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA 1998; 280: 2013–2019.
Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer: a meta-analysis of randomized controlled clinical trials. Ann Surg 1999; 229: 467–477.
Bollaert PE, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med 1998; 26: 645–650.
Briegel J, Forst H, Haller M, et al. Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study. Crit Care Med 1999; 27: 723–732.
Bhandari S, Turney JH. Survivors of acute renal failure who do not recover renal function. QJM 1996; 89: 415–421.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Neild, G.H. Multi-organ renal failure in the elderly. Int Urol Nephrol 32, 559–565 (2001). https://doi.org/10.1023/A:1014474305423
Issue Date:
DOI: https://doi.org/10.1023/A:1014474305423