Elsevier

Medicina Intensiva

Volume 30, Issue 6, September 2006, Pages 260-267
Medicina Intensiva

Originales
Epidemiología del fracaso renal agudo en las UCI españolas. Estudio prospectivo multicéntrico FRAMIEpidemiology of acute kidney failure in spanish ICU. Multicenter prospective study FRAMI

https://doi.org/10.1016/S0210-5691(06)74522-3Get rights and content

Objetivo

Estudio multicéntrico orientado a establecer la incidencia y el pronóstico del fracaso renal agudo (FRA) en las Unidades de Cuidados Intensivos (UCI) de nuestro país.

Material y método

Estudio prospectivo de los pacientes adultos ingresados durante 8 meses en 43 UCI españolas para detectar FRA definido como creatinina ≥ 2 mg/dl o diuresis < 400 ml/24 horas (en pacientes crónicos aumento de creatinina del 100%, excluyendo aquellos con creatinina basal ≥ 4 mg/dl).

Resultados

901 episodios de FRA (incidencia 5,7%), de los cuales el 55% lo presentaban en el momento del ingreso. Fueron debidos a necrosis tubular aguda (NTA) el 38,4%, prerrenal el 36,6%, y mixta el 21,2% de los episodios. Precisaron depuración renal (DER) el 38%.

La mortalidad fue del 42,3% durante el episodio de FRA (34,1% en los que ingresan en FRA, frente a 50,9% en los que lo desarrollan tras el ingreso), 80% en pacientes con síndrome hepatorrenal, 51,6% en NTA y 29,9% en prerrenal. Detectamos relación independiente con la mortalidad para la edad (OR 1,03), antecedente de diabetes (OR 2,06), desarrollo de FRA en la UCI (OR 2,51), oliguria (OR 5,76) y DER (OR 2,32). La recuperación de la función renal se produjo en el 85,6% de los supervivientes y en tan solo un 1,1% se mantenía la DER al alta de la UCI.

Calculamos el área bajo curva del APACHE II al ingreso (0,62), SOFA al inicio del FRA (0,68), índice de Liaño (0,7) y SOFA máximo (0,79).

Conclusiones

El FRA en pacientes de UCI no presenta una elevada incidencia pero sí alta mortalidad, presentando mayor gravedad cuando hace su aparición tras el ingreso. Sin embargo, en los pacientes que sobreviven, la recuperación es elevada. Los índices pronóstico habituales no son exactos en este grupo de pacientes, siendo el ISI y SOFA máximo el que muestra una relación más estrecha con la mortalidad.

Objective

Multicenter study oriented at establishing the incidence and prognosis of acute kidney failure (AKF) in the ICU of our country.

Material and methods

Prospective study of adult patients admitted over 8 months in 43 Spanish ICUs to detect AKF defined as creatinine ≥ 2 mg/dl or diuresis < 400 ml/24 hours (in chronic patients 100% increase of creatinine, excluding those with baseline creatinine ≥ 4 mg/dl).

Results

901 episodes of AKF (AKF episodes (incidence 5.7%), 55% of which occurred on admission. A total of 38.4% of the episodes were due to acute tubular necrosis (ATN), 36.6% to prerenal, and 21.2% to mixed. Renal depuration (RC) was required in 38%.

Mortality was 42.3% during the AKF episode (34.1% in those who were admitted with AKF versus 50.9% in those who developed it after admission), 80% in patients with Hepatorenal Syndrome, 51.6% in ATN and 29.9% in prerenal. We detect an independent relationship with mortality for age (OR 1.03), background of diabetes (OR 2.06), development of AKF in the ICU (OR 2.51), oliguria (OR 5.76) and RC (OR 2.32). Recovery of the kidney function occurred in 85.6% of the survivors and RC was maintained in only 1.1% on discharge from the ICU.

We calculated the area under the curve of APACHE II on admission (0.62), SOFA on onset of AKF (0.68), Liaño index (0.7) and maximum SOFA (0.79).

Conclusions

AKF in ICU patients does not show an elevated incidence but does have high mortality, presenting greater seriousness when it appears after admission. However, recovery is elevated in patients who survive. The usual prognostic indexes are not exact in this patient group, the ISA and maximum SOFA being those which shows a closer relationship with mortality.

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