Outcome of ICU patients requiring dialysis in an African institution

Introduction

Acute renal failure (ARF) is a common problem in ICUs and is associated with a high mortality rate [1, 2]. Early and aggressive management of renal dysfunction through intermittent or continuous renal replacement therapy (RRT) is now common practice. The objective of this study was to review the outcome of patients who received RRT in the multidisciplinary ICU of the Johannesburg Hospital, South Africa.

Methods

A review of ICU records between January 2003 and December 2004 of all patients requiring RRT in the ICU was performed. Demographic data, reason for ICU admission, presence of comorbidity, APACHE II score, the modality and duration of dialysis, as well as the outcome in the ICU were documented. This study was approved by the Human Research Ethics Committee of the University of the Witwatersrand, and statistical analysis carried out in conjunction with the Biostatistics Unit of the Medical Research Council of South Africa using the Stata release 8.0 statistical package.

Results

One hundred and fifty-six patients out of 2,200 admissions (January 2003 to December 2004) were initiated on RRT. One hundred and three patients were treated with intermittent haemodialysis (IHD), 47 of whom died (45.6%). Twenty-three patients underwent continuous venovenous haemodialysis, 20 (87%) of whom died. Twenty-two patients underwent both IHD and continuous venovenous haemodialysis, 15 (68.2%) of whom died. In eight patients there was no record of the mode of dialysis administered. Multivariate logistic regression suggested that the main factor associated with mortality was dialysis. Omitting the mode of dialysis, the presence of sepsis and the use of inotropes were independent risk factors associated with mortality.

Conclusion

Continuous RRT allows renal support in patients who would be unable to sustain IHD. The presence of sepsis and the use of inotropic support, rather than the mode of dialysis, are predictive of the outcome of ARF in the ICU. Of note, the overall mortality rate for ARF in this study appears to be lower than previously reported.