Skip to main content

Acute renal failure in patients with sepsis

The evaluation of acute renal failure (ARF) by the newly developed classification for ARF (RIFLE, standing for 'risk, injury, failure, loss, end-stage kidney disease') [1] in patients with sepsis has not yet been performed. We evaluated, retrospectively, the incidence of ARF and its risk factors, therapy, and outcome among patients with sepsis admitted to the Infectious Diseases Intensive Care Unit of the Hospital de Santa Maria between January 2005 and December 2006. ARF was defined by means of the RIFLE classification [1]. Sepsis was classified in accordance with the American College of Chest Physicians and the Society of Critical Care Medicine consensus [2]. In all, 182 patients (aged 56.2 ± 18.56 years (mean ± SD), 120 male, 162 Caucasian) were analyzed. Baseline characteristics of the patients are summarized in Table 1. Sixty-eight patients (37.4%) had ARF. By multivariate analysis, age more than 60 years (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.17 to 0.87, P = 0.002), male (OR 5.5, 95% CI 2.2 to 13.5, P < 0.0001), chronic kidney disease (OR 0.2, 95% CI 0.06 to 0.79, P = 0.021), Gram-negative-related infection (OR 0.38, 95% CI 0.16 to 0.89, P = 0.027), and a Simplified Acute Physiology Score, version II (SAPS II) > 50 (OR 0.14, 95% CI 0.06 to 0.31, P < 0.0001) were independently associated with ARF. Thirteen patients (3 with injury and 10 with renal failure) had received renal replacement therapy (12 receiving continuous venovenous hemodiafiltration, and 1 receiving intermittent hemodialysis). The mortality rate was 37.4%, and increased from 'normal' to 'failure'. Patients who did not die had renal function recovery. Multivariate analysis including age more than 60 years, gender, SAPS II > 50, comorbidity (namely cardiovascular disease), and ARF showed that SAPS II > 50 (OR 0.12, 95% CI 0.05 to 0.29, P < 0.0001) and ARF (OR 0.26, 95% CI 0.11 to 0.63, P = 0.003) were independent predictors of mortality.

Table 1 Baseline characteristics

Thus, ARF as determined by RIFLE is common among patients with sepsis, and increases mortality. Age, gender, chronic kidney disease, Gram-negative-related infection and severity of illness are independently associated with ARF in this setting.



acute renal failure


confidence interval


odds ratio


risk, injury, failure, loss, end-stage kidney disease


Simplified Acute Physiology Score, version II.


  1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, the ADQI workgroup: Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004, 8: R204-R212. 10.1186/cc2872

    Article  PubMed Central  PubMed  Google Scholar 

  2. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003, 31: 1250-1256. 10.1097/01.CCM.0000050454.01978.3B

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to José António Lopes.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

JAL, SJ, CR, and CS made substantial contributions to the conception and design of the study, to the acquisition of data, and to the analysis and interpretation of data. JAL, CR, AP, JN, FA, and MMP were involved in drafting the manuscript and revising it critically for important intellectual content. All authors read and approved the final manuscript.

Authors’ original submitted files for images

Below are the links to the authors’ original submitted files for images.

Authors’ original file for figure 1

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lopes, J.A., Jorge, S., Resina, C. et al. Acute renal failure in patients with sepsis. Crit Care 11, 411 (2007).

Download citation

  • Published:

  • DOI:


  • Confidence Interval
  • Intensive Care Unit
  • Multivariate Analysis
  • Renal Function
  • Chronic Kidney Disease