Nutritional status plays a crucial role in the mortality of critically ill patients with acute renal failure

2017 ◽  
Vol 66 (2) ◽  
pp. 309-318 ◽  
Author(s):  
Haiyan Zhang ◽  
Xiaodong Zhang ◽  
Lei Dong
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Nutritional Status ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Statistical Significance ◽  
Nutrition Intervention ◽  
Icu Discharge

We aimed to clarify associations between nutritional status and mortality in patients with acute renal failure. De-identified data were obtained from the Medical Information Mart for Intensive Care III database comprising more than 40,000 critical care patients treated at Beth Israel Deaconess Medical Centerbetween 2001 and 2012. Weight loss and body mass index criteria were used to define malnutrition. Data of 193 critically ill patients with acute renal failure were analyzed, including demographics, nutrition intervention, laboratory results, and disease severity. Main outcomes were in-hospital and 1-year mortality. The 1-year mortality was significantly higher in those with malnutrition than in those without malnutrition (50.0% vs 29.3%, p=0.010), but differences in in-hospital survival were not significant (p=0.255). Significant differences in mortality were found between those with malnutrition and without starting at the 52nd day after intensive care unit (ICU) discharge (p=0.036). No significant differences were found between men and women with malnutrition in in-hospital mortality (p=0.949) and 1-year mortality (p=0.051). Male patients requiring intervention with blood products/colloid supplements had greater risk of 1-year mortality, but without statistical significance. Nutritional status is a predictive factor for mortality among critically ill patients with acute renal failure, particularly 1-year mortality after ICU discharge.

scholarly journals Risk factors for death among critically ill patients with acute renal failure

2006 ◽  
Vol 124 (5) ◽  
pp. 257-263 ◽  
Author(s):  
Geraldo Bezerra da Silva Júnior ◽  
Elizabeth De Francesco Daher ◽  
Rosa Maria Salani Mota ◽  
Francisco Albano Menezes
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Mechanical Ventilation ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Liver Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Volume

CONTEXT AND OBJECTIVE: Acute renal failure is a common medical problem, with a high mortality rate. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure. DESIGN AND SETTING: Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza. METHODS: Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death. RESULTS: Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 ± 20 years (79 males; 62%). Death occurred in 80 (62.5%). 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. There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. 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). 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.

scholarly journals Use of a Low-Molecular-Weight Heparinoid (Danaparoid Sodium) for Continuous Renal Replacement Therapy in Intensive Care Patients

2001 ◽  
Vol 7 (4) ◽  
pp. 300-304 ◽  
Author(s):  
Edelgard Lindhoff-Last ◽  
Christoph Betz ◽  
Rupen Bauersachs
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Efficient Treatment ◽  
Intensive Care Patients

The purpose of this study was to evaluate the efficacy and safety of danaparoid in the treatment of critically ill patients with acute renal failure and suspected heparin-induced thrombocytopenia (HIT) needing renal replacement therapy (RRT). We conducted a retrospective analysis of 13 consecutive intensive care patients with acute renal failure and suspected HIT who were treated with danaparoid for at least 3 days during RRT. In eight patients, continuous venovenous hemofiltration was performed. The mean infusion rate of danaparoid was 140 ± 86 U/hour. Filter exchange was necessary every 37.5 hours. In five patients, continuous venovenous hemodialysis was used. A bolus injection of 750 U danaparoid was followed by a mean infusion rate of 138 ± 122 U/hour. Filters were exchanged every 24 hours. In 7 of 13 patients, even a low mean infusion rate of 88 ± 35 U/hour was efficient. Mean anti-Xa (aXa) levels were approximately 0.4 ± 0.2 aXa U/mL. Persistent thrombocytopenia despite discontinuation of heparin treatment was observed in 9 of 13 patients, owing to disseminated intravascular coagulation (DIC). HIT was confirmed by an increase in platelet count and positive heparin-induced antibodies in 2 of 13 patients. No thromboembolic complications occurred, but major bleeding was observed in 6 of 13 patients, which could be explained by consumption of coagulation factors and platelets due to DIC in 5 of 6 patients. Nine of 13 patients died of multiorgan failure or sepsis, or both. In none of these patients was the fatal outcome related to danaparoid treatment. In critically ill patients with renal impairment and suspected HIT, a bralus injection of 750 U danaparoid followed by a mean infusion rate of 50 to 150 U/hour appears to be a safe and efficient treatment option when alternative anticoagutation is necessary.

Study of incidence of acute renal failure and its associated factors and complications amongst patients admitted in intensive care unit of a tertiary care teaching hospital

2021 ◽  
Vol 11 (2) ◽  
pp. 108-111
Author(s):  
Rameshwar A Warkad ◽  
Keyword(s):  
Intensive Care Unit ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Critically Ill ◽  
Teaching Hospital ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Tertiary Care Teaching Hospital

Background: Impairment of renal function is a serious complication in critically ill patients. Mortality of acute renal failure remains high ranging from 35% to 86% despite haemodialysis therapy and substantial improvement of dialysis techniques. Therefore attention must be paid to the conditions favouring deterioration of renal function in order to prevent acute renal failure or to intervene in an early phase when less invasive therapies might be even more promising. Methods: This prospective study was conducted in a tertiary care teaching hospital in Mumbai from 1st January 2006 to 31st December 2006. All patients consecutively admitted in intensive care unit were studied. Results: Total number of patients admitted during the said period to the Intensive care Unit was 406, of which 50 had evidence of acute renal failure. The incidence of acute renal failure in the critically ill patients included in our study was 12.31%. There was a statistically significant difference in the incidence of fluid overload, oliguria and hyperkalemia between the pre-renal and renal failure groups. Conclusion: The incidence of acute renal failure in the critically ill patients was 12.31% and commonest predisposing factors associated with acute renal failure were acute insults like hypotension, sepsis and risk factors like age >50 years and pre-existing renal disease.

scholarly journals Nutrition in acute renal failure

2005 ◽  
Vol 123 (3) ◽  
pp. 143-147 ◽  
Author(s):  
Sérgio Mussi Guimarães ◽  
José Paulo Cipullo ◽  
Suzana Margareth Ajeje Lobo ◽  
Emmanuel de Almeida Burdmann
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Nutritional Status ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Support ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Traditional Methods

Nutritional status has been considered to be one of the possible determinants of mortality rates in cases of acute renal failure (ARF). However, most studies evaluating possible mortality indicators in ARF cases have not focused on the nutritional status, possibly because of the difficulties involved in assessing the nutritional status of critically ill patients. Although the traditional methods for assessing nutritional status are used for ARF patients, they are not the best choice in this population. The use of nutritional support for these patients has produced conflicting results regarding morbidity and mortality. This review covers the mechanisms and indicators of malnutrition in ARF cases and the types of nutritional support that may be used.

Chasing the Bucket: A Nursing view of Continuous Arterio-Venous Haemofiltration/Dialysis

1989 ◽  
Vol 75 (3) ◽  
pp. 153-158
Author(s):  
G. E. Watkinson
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Critically Ill ◽  
Nursing Staff ◽  
Critically Ill Patients ◽  
Major Advance ◽  
Intensive Care Patients ◽  
Intensive Care Nursing ◽  
Care Nursing

AbstractHaemofiltration was developed to meet the needs of intensive care patients with acute renal failure. It is a major advance in the management of these critically ill patients, as it is carried out at the bedside by the intensive care nursing staff

A Prospective Study of Continuous Venovenous Hemodiafiltration in Critically Ill Patients with Acute Renal Failure

1995 ◽  
Vol 10 (4) ◽  
pp. 187-192 ◽  
Author(s):  
Rinaldo Bellomo ◽  
Michael Farmer ◽  
Neil Boyce
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Confidence Interval ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii Score ◽  
Continuous Venovenous Hemodiafiltration

We studied the biochemical and the clinical consequences of the application of continuous venovenous hemodiafiltration to the management of acute renal failure in critically ill patients. One hundred consecutive surgical and medical ICU patients with acute renal failure were entered into a prospective clinical study at an intensive care unit of tertiary institution. Intervention included assessment of illness severity by APACHE II score on admission and by organ failure score prior to initiation of renal replacement therapy; treatment of patients with continuous venovenous hemodiafiltration; and measurement of biochemical variables prior to and after therapy. Outcome assessment included incidence of complications, duration of oliguria, duration of intensive care and hospital stays, and survival to hospital discharge. Measurements and main results included the following: mean patient age was 60.9 years (range 21–81 yr); mean APACHE II score, 28.6 (95% confidence interval; 27.4-29.8); and number of failing organs, mean, 4.1 (95% confidence interval; 3.8-4.4). At commencement of continuous venovenous hemofiltration with dialysis, 79% of patients were receiving inotropic drugs and 72% were septic, and, in 35%, bacteremia or fungemia was demonstrated. Renal replacement therapy was applied for a mean duration of 186.2 hours (95% confidence interval; 149.2-223.7), with a mean hourly net ultrafiltrate production of 621 mL (95% confidence interval; 594–648) and a mean urea clearance of 28.1 mL/min (95% confidence interval; 26.7-29.5). Azotemia was controlled in all patients (plasma urea < 30 mmol/L). During the more than 18,000 hours of treatment, there was no therapy-associated hemodynamic instability. Complications were rare. They included two cases of hemofilter rupture with minor blood loss and a single case of bleeding at the site of the vascular-access catheter. Forty-three patients survived to ICU discharge, and 40 survived to hospital discharge. Continuous venovenous hemodiafiltration is a safe and an effective form of renal replacement therapy in critically ill patients. In such patients, who have a high predicted mortality rate, it was associated with a 40% survival rate. These findings suggests that continuous venovenous hemodiafiltration may be ideally suited to patients with multisystem organ failure with acute renal failure.

scholarly journals IMPORTANCE OF NUTRITION ASSESSMENT IN CRITICALLY ILL PATIENTS

2021 ◽  
Vol 9 (Spl-1- GCSGD_2020) ◽  
pp. S55-S61
Author(s):  
V. Suganya ◽  
◽  
Vasantha Esther Rani ◽  
Keyword(s):  
Nutritional Status ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Assessment ◽  
Objective Assessment ◽  
Nutrition Therapy ◽  
Nutrition Intervention ◽  
Prolonged Stay ◽  
Duration Of Stay ◽  
Icu Discharge

A timely assessment of nutritional status in critically ill patients is crucial. This was an observational prospective hospital study carried out for 3 months from December 2019 to February 2020 in an ICU in a multispecialty hospital in Madurai, Tamilnadu, India. All adult patients with ≥ 72 hours of ICU-LOS were included and their nutritional assessment was completed by SGA (Subjective Global Assessment) forms within 24 hours of ICU admission. Data collected regarding variables such as Age, Nutritional status, APACHE IV, SOFA score, presence of Comorbidities. All patients were studied about their duration of stay in ICU and hospital, Predicted Mortality rate, & discharge outcome.120 patients were involved in the study in the age 62. 2 ± 14.years, among this 55.3% were males and rest 44.7% were females. Their complete nutritional assessment revealed that 50%, 43%, and 17% were well nourished, moderately malnourished, severely malnourished respectively. A strong correlation was observed between nutritional status, morbidity, and their prolonged stay in ICU. Mean ICU & hospital mortality percentage was 37%, 45% respectively. The average duration of stay in the ICU and hospital was 13, 20 days respectively. Participants anthropometric data decreased considerably (mean weight, MUAC, calf circumference) during ICU discharge day. BMI comparison of admission and discharge didn’t show significant change. Timely nutrition intervention and medical nutrition therapy reduce the duration of patient stay in ICU and hospital and improved patient outcomes. The disease severity scoring system can be used as guidance for objective assessment of disease outcomes and estimation of the chance of recovery.

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