Secular trends in the survival of patients with dialytic acute renal failure (ARF) in an intensive care unit (ICU)

In 1997, we started performing CVVH/HD in our ICU, which allowed us to improve the metabolic control of our dialysis patients. We sought to investigate the trends in mortality rates of ARF patients treated in our ICU from January 1992 to December 1998. The APACHEII score and risk of death of all patients (n = 10723, age 61 ± 18 years, 62% males) and of patients with ARF submitted to dialysis therapies (n = 256, age 61 ± 18 years, 70% males) are shown in the Table.

Table

In 1998, for the first time, the mortality in the ARF population was lower than the expected mortality (risk of death). Comparing the 1992-1996 period with 1997-1998, there was no reduction in the expected mortality (49% versus 44%; P = 0.46), but there was a significant reduction in the ICU mortality (62% versus 48%; P = 0.04). This improvement in survival could be due to an overall improvement in our standards of care or in the dialytic therapy.