Hospital Related Epidemiologic Data

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FIGURE 8-18

ARF

Community-acquired (SCr at admission>3 mg/dL)

Hospital-acquired (SCr at admission<1.5 mg/dL)

ATN

41.8

58.2

Prerenal

47.5

52.5

Obstructive

77.3

22.7

Total

49.7

50.3

FIGURE 8-18 (Continued)

B, With the same two groups, acute tubular necrosis (ATN) predominated among the hospital-induced ARF group, whereas the obstructive form was the main cause of community-acquired ARF. In conclusion, the hospital could be considered an ARF generator, particularly of the most severe forms. Nonetheless, these iatrogenic ARF cases are usually "innocent," and are an unavoidable consequence of diagnostic and therapeutic maneuvers. (Data from Liano et al. [1].)

FIGURE 8-19

FIGURE 8-19

Acute renal failure: initial hospital location and mortality. A, Initial departmental location of ARF patients in a hospital in a Western country. The majority of the cases initially were seen in medical, surgical, and intensive care units (ICUs). The cases initially treated in nephrology departments were community acquired, whereas the ARF patients in the other settings generally acquired ARF in those settings. Obstetric-gynecologic ARF cases have almost disappeared. ARF of traumatic origin is also rare, for two reasons: 1) polytrauma patients are now treated in the ICU and 2) early and effective treatments applied today to trauma patients at the accident scene, and quick transfer to hospital, have decreased this cause of ARF. B, Mortality was greater for patients initially treated in the ICU and lower in the nephrology setting than rates observed in other departments. These figures were obtained from 748 ARF patients admitted to 13 different adult hospitals. (Data from Liano et al. [1].)

Investigator, Year

Acute Renal Failure in Hospitalized Patients (per 1000 admissions)

Hou et al., 1983*

49.0

Shusterman et al., 1987*

19.0

Lauzurica et al., 1989*

First period

16.0

Second period

6.5

Abraham et al, 1989

1.3

Madrid Study, 1992

1.5

* Case-control studies.

EPIDEMIOLOGIC VARIABLES

FIGURE 8-20

Epidemiologic variable. The incidence of hospital-acquired acute renal failure (ARF) depends on what epidemiologic method is used. In case-control studies the incidence varied between 49 and 19 per thousand. When the real occurrence was measured in large populations over longer intervals, the incidence of hospital-acquired ARF decreased to 1.5 per thousand admissions. (Data from [1,5,16,17,18].)

* Case-control studies.

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