Renal Failure Rises While Death Risk Declines

Emergency staffs cope well with an
increasing number of ARF patients
© Picture Disk

A study led by Jay L. Xue, Ph.D., of the United States Renal Data System (USRDS) examined trends in ARF in a large sample of hospitalised Medicare beneficiaries. "The key finding of this study is that the incidence of ARF steadily increased in U.S. elderly patients hospitalised from 1992 to 2001," comments Xue says. "Our study shows that patients with ARF have longer hospital stays and higher mortality than those without ARF."

A study led by Dr. Sushrut S. Waikar of Harvard Medical School focused on trends in mortality risk in about 5.6 million hospital discharges of patients with ARF between 1988 and 2002, identified from nationally representative database of hospitalisations. As in Xue's study, the results showed a sharp increase in ARF rates. Adjusted for population, the overall incidence of ARF more than quadrupled from 1988 to 2002. Although increased awareness and diagnosis might play some role, the researchers believe they cannot entirely explain the trend toward rising rates of ARF.

Meanwhile, rates of in-hospital death for patients with ARF decreased dramatically: from 40 to 20 percent overall, and from 41 to 28 percent for patients with ARF requiring dialysis. "There have been numerous advances in the care of critically ill patients in the past 15 years," Waikar comments. "The improvement in survival among patients with severe kidney failure suggests that doctors are getting better at treating these extremely ill patients. “Another possible explanation for this improvement is advances in dialysis technology.”

In the future, the rising incidence of ARF is likely to place increasing strain on an already burdened health care system, Waikar and colleagues believe. They conclude that, "despite declining mortality rates, outcomes associated with ARF remain unacceptably poor. New strategies for the prevention and treatment of ARF are desperately needed."; Source: American Society of Nephrology (ASN)