Prognosis and Serum Creatinine Levels In Acute Renal Failure at the Time of Nephrology Consultation: An Observational Cohort Study

Jose Ramon Perez-Valdivieso; Maira Bes-Rastrollo; Pablo Monedero; Jokin de Irala; Francisco Javier Lavilla

Disclosures

BMC Nephrology 

In This Article

Results

Six hundred and forty-six patients were evaluated, among them one hundred and eighty-eight died in-hospital. The demographics and baseline clinical characteristics are shown in Table 1 . Subjects in the ≥ 101% increment of creatinine group were more likely to be female (p = 0.01), had impaired prior food intake (p = 0.02), and required more renal replacement therapy (p < 0.001). The ≥ 101% increment of creatinine group was associated with high prevalence of community-acquired ARF (p = 0.02), and worse Karnofsky scoring (p = 0.015). The group with ≥ 101% increment of creatinine was also associated with higher Liano scoring at the time of nephrology consultation (p < 0.001), including higher prevalence of hypotension (p < 0.001), oliguria (p < 0.001), jaundice (p = 0.008), coma (p = 0.027), and were on mechanical ventilation (p = 0.002). RIFLE classes reached during the ARF were more severe in subjects in the ≥ 101% increment of creatinine group (p < 0.001). There was a higher prevalence of diabetes (p = 0.037) in this group.

The ≥ 101% increment group was associated with significant increased total inhospital mortality (35.6% vs. 22.6%, P < 0.001), with an adjusted odds ratio of 1.81 (95% CI: 1.08–3.03) ( Table 2 ). Moreover, those patients in the ≥ 101% increment group who required continuous renal replacement therapy presented a higher increase of inhospital mortality (62.7% vs 46.4%, P = 0.048), with an adjusted odds ratio of 2.66 (95% CI: 1.00–7.21) ( Table 3 ). We noticed that patients in the ≥ 101% increment group had a higher mean serum creatinine level in comparison to their baseline level (114.72% vs. 37.96%) at hospital discharge ( Table 4 ). In the ≥ 101% increment group, creatinine was an adjusted 48.92% (95% CI: 13.05–84.79) higher than the < 101% increment group.

The overall mortality rate was 337 deaths (52.2%) in 6 months. According to the Kaplan-Meier plot, the ≥ 101% increment group also had a statistically significant higher mortality rate in this period as compared with the < 101% increment group (Log Rank test = 0.012) (Figure 1). During the first 60 days of follow-up 175 deaths (27.1%) occurred.

Six-month survival after starting the nephrology consultation according to increase creatinine percentage*.

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