The long-term outcome after acute renal failure Presented by Ri  顏玎安
Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>...
Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>...
Annual incidence and mortality rate Annual  incidence rate:11.0/10,000/year Annual mortality rate:7.3/10,000/year
Risk factors <ul><li>Risk factors: </li></ul><ul><ul><li>Previous heart dx </li></ul></ul><ul><ul><li>Stroke </li></ul></u...
Popular-based risk factors of ARF Prognosis for long-term survival and renal recovery in critically ill patients with seve...
Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>...
Survival  <ul><li>Survival rates  </li></ul><ul><ul><li>90 days: 46~74% </li></ul></ul><ul><ul><li>6 months: 55~73% </li><...
Survival Rate
Factors V.S Long-term mortality <ul><li>Associated ….. </li></ul><ul><li>Older age </li></ul><ul><li>Greater burden of co-...
Factors V.S Long-term survival <ul><li>Not significantly associated… </li></ul><ul><li>Renal replacement therapy modality ...
Factors associated with death in 1 year Prognosis for long-term survival and renal recovery in critically ill patients wit...
Factors associated with death in 1 year Prognosis for long-term survival and renal recovery in critically ill patients wit...
Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>...
Renal recovery <ul><li>Important clinical measure of morbidity </li></ul><ul><li>Recovery to independence from RRT  contin...
Renal recovery <ul><li>No studies have specifically addressed what factors are predictive of long-term recovery. </li></ul...
Renal recovery-  Recurring need for renal replacement therapy <ul><li>Study of critically ill patients with severe acute r...
Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>...
Health-related quality of life & Health economic implications <ul><li>HRQoL is generally good  and acceptable by survivors...
Plasma concentration of tumor necrosis factor alpha may predict the outcome of patients with acute renal failure   ~Kidney...
Plasma concentration of tumor necrosis factor alpha may predict the outcome of patients with acute renal failure   ~Kidney...
Predictors of mortality in patients with acute renal failure   ~Acta Medica. 49(3): 183-8,2006 <ul><li>3 independent predi...
Key messages <ul><li>Factors independently associated with long-term mortality: </li></ul><ul><ul><li>High-mortility and p...
Factors associated with mortality in acute renal failure (ARF) in children   ~Pediatirc Nephrology ;Jan   2006  <ul><li>Th...
<ul><li>Type of clinical presentation:Nonoliguria </li></ul>Factors associated with mortality in acute renal failure (ARF)...
<ul><li>In multinominal logistic regression analysis, only  oliguria  ( P =0.07) and  age group  ( P =0.049) were associat...
<ul><li>In the Cox model survival analysis,  oliguria  ( P =0.003) and  sepsis  ( P =0.03) influenced survival  </li></ul>...
Factors associated with mortality in acuterenal failure (ARF) in children   ~Pediatirc Nephrology ;Jan 2006 Oliguria non-O...
Reference: <ul><li>The long-term outcome after acute renal failure </li></ul><ul><li>- Curr Opin Crit Care 12:561–566 .   ...
Reference <ul><li>Plasma concentration of TNF-alpha may predict the outcome of patients with acute renal failure </li></ul...
~Thank you~ ~Mucha gracias!
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The long-term outcome after acute renal failure.ppt

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The long-term outcome after acute renal failure.ppt

  1. 1. The long-term outcome after acute renal failure Presented by Ri 顏玎安
  2. 2. Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>Long-term outcomes and prognosis for survivors of critical illness </li></ul><ul><ul><ul><li>Survival </li></ul></ul></ul><ul><ul><ul><li>Renal recovery </li></ul></ul></ul><ul><ul><ul><li>Heath-related quality of life </li></ul></ul></ul><ul><ul><ul><li>Health economics effects </li></ul></ul></ul>
  3. 3. Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>Long-term outcomes and prognosis for survivors of critical illness </li></ul><ul><ul><ul><li>Survival </li></ul></ul></ul><ul><ul><ul><li>Renal recovery </li></ul></ul></ul><ul><ul><ul><li>Heath-related quality of life </li></ul></ul></ul><ul><ul><ul><li>Health economics effects </li></ul></ul></ul>
  4. 4. Annual incidence and mortality rate Annual incidence rate:11.0/10,000/year Annual mortality rate:7.3/10,000/year
  5. 5. Risk factors <ul><li>Risk factors: </li></ul><ul><ul><li>Previous heart dx </li></ul></ul><ul><ul><li>Stroke </li></ul></ul><ul><ul><li>Pulmonary dx </li></ul></ul><ul><ul><li>DM </li></ul></ul><ul><ul><li>Connective tissue dx </li></ul></ul><ul><ul><li>Chronic renal dysfunction </li></ul></ul><ul><ul><li>Alcoholism </li></ul></ul>
  6. 6. Popular-based risk factors of ARF Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study, Critical Care 2005, 9 :R700-R709
  7. 7. Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>Long-term outcomes and prognosis for survivors of critical illness </li></ul><ul><ul><ul><li>Survival </li></ul></ul></ul><ul><ul><ul><li>Renal recovery </li></ul></ul></ul><ul><ul><ul><li>Heath-related quality of life </li></ul></ul></ul><ul><ul><ul><li>Health economics effects </li></ul></ul></ul>
  8. 8. Survival <ul><li>Survival rates </li></ul><ul><ul><li>90 days: 46~74% </li></ul></ul><ul><ul><li>6 months: 55~73% </li></ul></ul><ul><ul><li>1 year: 57~65% </li></ul></ul><ul><ul><li>5 years:65~70% </li></ul></ul>
  9. 9. Survival Rate
  10. 10. Factors V.S Long-term mortality <ul><li>Associated ….. </li></ul><ul><li>Older age </li></ul><ul><li>Greater burden of co-morbid illness </li></ul><ul><ul><li>Assessed by Charlson co-morbidity index </li></ul></ul><ul><li>Chronic liver disease </li></ul><ul><li>High severity of illness </li></ul><ul><ul><li>Assessed by APACHE Ⅱor SOFA scores </li></ul></ul><ul><li>Severe sepsis/septic shock </li></ul><ul><li>Postcardiac surgical acute renal failure </li></ul>
  11. 11. Factors V.S Long-term survival <ul><li>Not significantly associated… </li></ul><ul><li>Renal replacement therapy modality </li></ul><ul><ul><li>CRRT V.S IHD </li></ul></ul><ul><li>Sex </li></ul><ul><li>Oliguria </li></ul><ul><li>Need for mechanical ventilation </li></ul><ul><li>Etiology of sARF </li></ul><ul><li>Indication for RRT </li></ul><ul><li>Pre-existing renal disease </li></ul><ul><li>High intensity of prescribed RRT: </li></ul><ul><ul><li>only improve survival in short term </li></ul></ul>
  12. 12. Factors associated with death in 1 year Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study, Critical Care 2005, 9 :R700-R709
  13. 13. Factors associated with death in 1 year Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study, Critical Care 2005, 9 :R700-R709
  14. 14. Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>Long-term outcomes and prognosis for survivors of critical illness </li></ul><ul><ul><ul><li>Survival </li></ul></ul></ul><ul><ul><ul><li>Renal recovery </li></ul></ul></ul><ul><ul><ul><li>Heath-related quality of life </li></ul></ul></ul><ul><ul><ul><li>Health economics effects </li></ul></ul></ul>
  15. 15. Renal recovery <ul><li>Important clinical measure of morbidity </li></ul><ul><li>Recovery to independence from RRT continues after hospital discharge </li></ul><ul><li>Peak recovery rate: 90 days with 60~70% independent form RRT </li></ul><ul><li>Long term recovery rate : not well described </li></ul>
  16. 16. Renal recovery <ul><li>No studies have specifically addressed what factors are predictive of long-term recovery. </li></ul><ul><li>Factors associated with reduced recovery </li></ul><ul><ul><li>Older age </li></ul></ul><ul><ul><li>Female sex </li></ul></ul><ul><ul><li>The presence of co-morbidities, esp CKD </li></ul></ul><ul><ul><li>Parenchymal etiology of ARF </li></ul></ul><ul><ul><li>Late initiation of RRT </li></ul></ul><ul><ul><li>Use of conventional intermittent RRT </li></ul></ul>
  17. 17. Renal recovery- Recurring need for renal replacement therapy <ul><li>Study of critically ill patients with severe acute renal failure with normal preexisting kidney function </li></ul><ul><li>Low recurrence rate for renal replacement therapy after initial recovery. </li></ul><ul><li>~Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. By Schiffl H. Nephrol </li></ul><ul><li>- Dial Transplant 2006; 21:1248–1252. </li></ul>
  18. 18. Introduction <ul><li>Popular-based incidence and risk factors for developing severe acute renal failure </li></ul><ul><li>Long-term outcomes and prognosis for survivors of critical illness </li></ul><ul><ul><ul><li>Survival </li></ul></ul></ul><ul><ul><ul><li>Renal recovery </li></ul></ul></ul><ul><ul><ul><li>Heath-related quality of life </li></ul></ul></ul><ul><ul><ul><li>Health economics effects </li></ul></ul></ul>
  19. 19. Health-related quality of life & Health economic implications <ul><li>HRQoL is generally good and acceptable by survivors of critically illness and ARF </li></ul><ul><li>Provision of RRT in critically ill patients with sever ARF is expensive </li></ul>
  20. 20. Plasma concentration of tumor necrosis factor alpha may predict the outcome of patients with acute renal failure ~Kidney and Blood Pressure Research. 29(4):203~209, 2006 <ul><li>Background/Aims: </li></ul><ul><ul><li>Plasma TNF-alpha </li></ul></ul><ul><ul><ul><li>is frequently elevated chronic renal failure on HD </li></ul></ul></ul><ul><ul><ul><li>correlates with mortality </li></ul></ul></ul><ul><li>Results: </li></ul><ul><ul><li>TNF-alpha in ARF patients </li></ul></ul><ul><ul><ul><li>Markedly higher (70ng/ml) than reference value (<5 pg/ml) </li></ul></ul></ul><ul><ul><ul><li>Significantly lower than HD patients (216 pg/ml) </li></ul></ul></ul>
  21. 21. Plasma concentration of tumor necrosis factor alpha may predict the outcome of patients with acute renal failure ~Kidney and Blood Pressure Research. 29(4):203~209, 2006 <ul><li>Results : </li></ul><ul><ul><li>TNF-alpha in ARF patients </li></ul></ul><ul><ul><ul><li>Remained elevated in polyuric phase </li></ul></ul></ul><ul><ul><ul><li>Initially lower than70 ng/ml predicted the beneficial outcome with sensitivity of 64%, specificity of 70% </li></ul></ul></ul><ul><li>Conclusions: </li></ul><ul><ul><li>TNF-alpha may predict the outcome of ARF </li></ul></ul><ul><ul><li>TNF-alpha remained elevated at polyuric phase despite marked improvement of excretory kidney func. </li></ul></ul>
  22. 22. Predictors of mortality in patients with acute renal failure ~Acta Medica. 49(3): 183-8,2006 <ul><li>3 independent predictors of mortality </li></ul><ul><ul><li>Increased APACHE Ⅲ score </li></ul></ul><ul><ul><li>Presence of cor-morbid conditions </li></ul></ul><ul><ul><li>Low serum albumin level </li></ul></ul>
  23. 23. Key messages <ul><li>Factors independently associated with long-term mortality: </li></ul><ul><ul><li>High-mortility and pre-existing co morbidities, liver disease, higher APACHE score on ICU admission, septic shock, albumin level </li></ul></ul><ul><li>Majority of patients with sARF will die </li></ul><ul><li>In those who survive : majority will recover renal function and become independent of RTT within 1 year </li></ul>
  24. 24. Factors associated with mortality in acute renal failure (ARF) in children ~Pediatirc Nephrology ;Jan 2006 <ul><li>The most affected age were newborns and infants </li></ul><ul><li>Mechanism: </li></ul>
  25. 25. <ul><li>Type of clinical presentation:Nonoliguria </li></ul>Factors associated with mortality in acute renal failure (ARF) in children ~Pediatirc Nephrology ;Jan 2006
  26. 26. <ul><li>In multinominal logistic regression analysis, only oliguria ( P =0.07) and age group ( P =0.049) were associated with mortality </li></ul>Factors associated with mortality in acute renal failure (ARF) in children ~Pediatirc Nephrology ;Jan 2006
  27. 27. <ul><li>In the Cox model survival analysis, oliguria ( P =0.003) and sepsis ( P =0.03) influenced survival </li></ul>Factors associated with mortality in acute renal failure (ARF) in children ~Pediatirc Nephrology ;Jan 2006
  28. 28. Factors associated with mortality in acuterenal failure (ARF) in children ~Pediatirc Nephrology ;Jan 2006 Oliguria non-Oliguria With sepsis Without sepsis
  29. 29. Reference: <ul><li>The long-term outcome after acute renal failure </li></ul><ul><li>- Curr Opin Crit Care 12:561–566 . </li></ul><ul><li>Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. By Schiffl H. </li></ul><ul><li> -Nephrol Dial Transplant 2006; 21:1248–1252. </li></ul><ul><li>Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Bagshaw SM, Laupland KB, Doig CJ, et al. -Crit Care 2005; 9:R700–R709 </li></ul><ul><li>Predictors of mortality in patients with acute renal failure </li></ul><ul><ul><li>Acta Medica. 49(3): 183-8, 2006 </li></ul></ul>
  30. 30. Reference <ul><li>Plasma concentration of TNF-alpha may predict the outcome of patients with acute renal failure </li></ul><ul><ul><li>Kidney and Blood Pressure research. 29(4):203-9, 2006 </li></ul></ul><ul><li>Factors associated with mortality in acute renal failure (ARF) in children </li></ul><ul><ul><li>Pediatric Nephrology;Jan 2006, Vol.21, Issue 1,p106-9 </li></ul></ul>
  31. 31. ~Thank you~ ~Mucha gracias!

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