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Many ICU Patients Experience Kidney Failure

Septic shock is most common cause of problems, study finds

TUESDAY, Aug. 16, 2005 (HealthDay News) -- An estimated 6 percent of patients in hospital intensive-care units experience acute kidney failure, and 60 percent of these people die in the hospital, a new study concludes.

An international research team looked at the problem of acute kidney failure in intensive-care units (ICUs) in 54 hospitals in 23 countries. The researchers found that of 29,269 patients admitted to ICUs, 5.7 percent had acute kidney failure during their stay in the units. Of these, 1,260 patients needed dialysis.

"Going to an ICU, wherever you go, seems to be associated with a high incidence of acute renal failure," said study co-author Dr. John A. Kellum, a professor of critical care medicine at the University of Pittsburgh.

The most common cause of acute kidney failure in ICUs was hospital-acquired septic shock, which was to blame for 47.5 percent of the failure cases, the study found. Septic shock is a severe infection that leads to low blood pressure. The result: Vital organs, such as the kidneys, liver, brain and heart may not function properly or fail, according to the National Library of Medicine.

About 30 percent of patients had kidney trouble when they were admitted to the hospital, Kellum and his colleagues found.

Among those who developed acute kidney failure and survived, 13.8 percent were dependent on dialysis when they left the hospital. For the others, dialysis was able to return their kidney function to normal, Kellum said.

The findings appear in the Aug. 17 issue of the Journal of the American Medical Association.

"This is a bigger problem than was previously understood," Kellum said. And it's "a problem that is only going to increase as the number of patients admitted to ICUs increases, which has been a growing factor as the population ages, and high-risk surgery expands the bounds of what can be done," he added.

In the United States, the problem is as serious as in other countries, Kellum said. "Roughly 5 million people in the U.S. go to the ICU every year," he said. "So, if one in 20 are developing acute renal failure that means that about 250,000 people develop acute renal failure each year in the U.S."

One expert said these findings confirm what he already knew.

"This is exactly what we see in clinical practice," said Dr. Chirag Parikh, an assistant professor of nephrology at Yale University School of Medicine. "The sad part is that nobody had put it together in one document across all countries before. But it's the same sad state of affairs."

One factor that contributes to the high mortality rate in acute kidney failure cases is the time it takes to recognize the problem, Parikh said. "By the time a nephrologist is called in, it's usually too late," he said.

Parikh believes that to diagnose acute renal failure early, doctors need new and faster ways to identify patients at risk of kidney failure. "We need a biomarker for defining renal injury," he said.

Parikh believes that more funding and research is needed in acute renal failure. "Otherwise, the outcomes in the ICU will not improve," he said.

More information

The National Institute of Diabetes and Digestive and Kidney Diseases can tell you more about kidney disease.

SOURCES: John A. Kellum, M.D., professor, critical care medicine, University of Pittsburgh; Chirag Parikh, M.D., Ph.D., assistant professor, nephrology, Yale University School of Medicine, New Haven, Conn.; Aug. 17, 2005, Journal of the American Medical Association
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