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Incidence and outcome of acute renal failure necessitating renal replacement therapy after trauma

Introduction

Acute renal failure (ARF) requiring renal replacement therapy (RRT) is uncommon in trauma patients. The aim of this study was to assess incidence and outcome in this patient group.

Methods

Adult trauma patients with ARF treated with RRT at Ullevaal University Hospital between 1 January 1996 and 31 December 2007 were retrospectively reviewed. The hospital is the regional trauma referral centre for approximately 1.93 million adult (>18 years) persons. Individuals were identified and data were collected using several institutional registries in addition to the Norwegian renal registry. Patients were grouped according to presence of rhabdomyolysis based on peak serum creatine kinase levels exceeding 10,000 U/l or not. Categorical data were compared employing the two-sided Pearson chi-square test, whereas continuous data were compared utilizing the two-tailed Mann–Whitney U test.

Results

There were 78,345 hospital admissions due to trauma during the study period, 42 of these underwent RRT for ARF (after excluding one person due to low age, three with nonrenal indications for RRT and another three with chronic renal failure). The incidence rate of post-traumatic ARF requiring RRT was 0.54‰, and was higher in males compared with females (33.72 vs. 6.05 per million persons, P < 0.01). The patients' age was median (range) 46.4 (18 to 84) years, and 85.7% were males. Mortality rates were 23.8% (ICU/hospital), 35.7% (3 months) and 40.5% (1 year). Renal recovery, defined as independency from RRT, occurred in all survivors after 3 months and 1 year. Rhabdomyolysis was present in 18 persons (42.9%) and was only registered in males. Trauma patients with rhabdomyolysis were significantly younger (33.0 vs. 57.0 years, P = 0.01), needed RRT earlier (3.0 vs. 6.5 days, P = 0.02) and had lower 3-month (16.7 vs. 50.0%, P = 0.03) and 1-year (22.2 vs. 54.2%, P = 0.04) mortality rates compared with nonrhabdomyolytic persons.

Conclusion

Post-traumatic ARF requiring RRT is rare and mainly affects males of young age. There is still a considerable mortality rate in these patients, and it seems that rhabdomyolytic persons have a more favourable outcome compared with those without rhabdomyolysis. Among survivors, recovery of renal function is often seen, and few become dependent on chronic RRT.

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Beitland, S., Moen, H. & Os, I. Incidence and outcome of acute renal failure necessitating renal replacement therapy after trauma. Crit Care 13, P262 (2009). https://doi.org/10.1186/cc7426

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Keywords

  • Creatine Kinase
  • Acute Renal Failure
  • Trauma Patient
  • Renal Replacement Therapy
  • Creatine Kinase Level