Assessment of reversible risk factors causing acute-on-chronic renal failure.

ABSTRACT

Summary: The present study was designed to evaluate the risk factors and their degree of reversibility in cases of acute-on-chronic renal failure admitted to a tertiary care hospital over a period of one year, i.e., from November, 2006 to October, 2007. Material: In this study 100 patients of acute-on-chronic renal failure (rise in serum creatinine of 0.5 mg/dl, if baseline serum creatinine was < 3 mg/dl or rise of 1 mg/dl, if baseline was > 3 mg/dl within a one-week period) were included and various reversible risk factor(s) and the degree of reversibility of renal failure was determined. Methods: A thorough clinical evaluation and investigations of all patients was done and they were put on conservative management along with specific management of reversible factor(s) and haemodialysis, whereever needed. The observations of various parameters were recorded at presentation (baseline) and subsequently at 1 week and 2 week periods which included 24-hour urine volume, blood urea, serum creatinine, and creatinine clearance. Reversibility of these parameters was then statistically analysed. To compare the degree of reversibility, the patients were divided into 4 groups at the time of admission depending upon their GFR; group 3 with GFR 30 - 59 ml/min, group 4 with GFR 15 - 29 ml/min, group 5a with GFR 5 - 15 ml/min, and group 5b with GFR < 5 ml/min, respectively. Results: Majority of patients were found to have more than one reversible risk factor. These were hyperuricaemia (89), electrolyte imbalance (51), infection/sepsis (47), accelerated hypertension (21), volume depletion (18), urinary tract obstruction (16), and hypotension (7). A considerable degree of reversibility was detected, maximum being in volume depletion and urinary tract obstruction. Conclusions: Therefore it was concluded that patients presenting in a severe uraemic state may not be suffering from ESRD and each patient should be investigated for the presence of reversible risk factor(s) so that renal function can be restored and hence the need of renal replacement therapy can be delayed.