Morbidity Mortality from Acute Renal Failure

Reported mortality rates for ARF have remained the same from before to after the advent of dialysis: 40 to 90 percent.1314 This statistic reflects a changing epidemiology and etiology of ARF. Before the availability of effective dialysis, many young patients died directly of complications specific to ARF. Now that dialysis effectively treats life-threatening complications of ARF, the patient's age and underlying diseases determine mortality from ARF. ARF has become an index of the severity of patients' other disease processes. With the advent of dialysis, the most common causes of death with aRf are sepsis, cardiac, and pulmonary failure.

This is not to imply that ARF is a benign disease: even in those patients not requiring dialysis, mortality was 31 percent in patients with ARF compared with only 8 percent in matched patients without ARF.15 Even after adjusting for comorbidity, the odds ratio for dying in patients with ARF was 4.9 compared with patients without ARF.

Mortality rates are generally less for nonoliguric ARF (more than 400 mL/day) compared with oliguric ARF (less than 400 mL/day). This difference is because drug-induced nephrotoxicity and interstitial nephritis usually cause nonoliguric ARF. 16

Approximately 20 to 60 percent of patients experiencing ARF will require dialysis during their hospital stay. 17 The majority of these patients will recover, with only 25 percent requiring long-term dialysis.18

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