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Acute renal failure in the intensive care unit: aetiological and predisposing factors and outcome.

BACKGROUND: Acute renal failure (ARF) in the intensive care unit (ICU) complicates 20 to 35% of admissions worldwide. There is no information on the pattern of ARF in our ICU and factors that influence survival.

OBJECTIVE: To determine the magnitude of acute renal failure, and outcome among patients at an ICU in Nigeria.

METHODS: Adult patients requiring intensive care, and with ARF were recruited. Severity of ARF was assessed using the Liano prognostic scoring system and a modified version of APACHE II prognostic scores. Haemodialysis was offered when indicated. Management outcomes were noted while a relationship was sought between severity of ARF and outcome.

RESULTS: Forty (19.6%) of the 204 patients managed during the period had ARF. These included 28 (70%) males and 12 (30%) females. Twelve (30%) of the patients had head injury while eight (20%) had major burns. Surgical sepsis accounted for seven (17.5%), while six (15%) patients had advanced metastatic carcinoma. Multiple fractures accounted for four (10%) while other causes accounted for the remaining 16 (40%). The mean serum creatinine and urea were 863.3+95umol per litre and 19.45(4.1) mmol per litre respectively. The Liano scores ranged from 33% to 99% , mean of 61 + or - 4.2%) while modified APACHE II score ranged from 5-19 (mean of 11 + or - 3.2). There was a significant correlation between the Liano scores and outcome (p<0.007) while the modified APACHE II score did not influence the outcome (P>0.05). Eighty percent of patients who had two or more organ failure died compared to 20% of the patients with less than two organ failure. Eight (20%) patients survived. Dialysis therapy significantly influenced outcome as 100% of the dialysed patients survived compared to 80% of those who were not.

CONCLUSION: Acute renal failure presents a continuing challenge in the ICU setting with attendant of high morbidity and mortality. Dialysis significantly influences survival, hence, the service should be provided in every intensive care unit.

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