Cause of acute tubular necrosis affects its prognosis. The Auriculin Anaritide Acute Renal Failure Study Group.

Abstract

BACKGROUND:

Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into nephrotoxic, ischemic, or mixed.

OBJECTIVE:

To test the hypothesis that the cause of ATN affects its clinical outcome.

METHODS:

The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure nephrotoxic, pure ischemic, or mixed nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes.

RESULTS:

Mortality was 10% in the nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the nephrotoxic group. Among patients with ischemic ATN, dialysis-free survival improved significantly and mortality tended to decline with advancing age.

CONCLUSIONS:

Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious commorbidities in the ischemic ATN group. Advancing age was associated with improved dialysis-free survival and a tendency toward reduced mortality in patients with ischemic ATN.

• Authors: L S Weisberg, R L Allgren, F C Genter, B R Kurnik
• Journal: Archives of internal medicine (Arch Intern Med) Vol. 157 Issue 16 Pg. 1833-8 (Sep 08 1997) ISSN: 0003-9926 [Print] United States
• PMID: 9290542 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Diuretics
• Peptide Fragments
• anaritide
• Atrial Natriuretic Factor

Topics

• Adult
• Aged
• Atrial Natriuretic Factor (therapeutic use)
• Diuretics (therapeutic use)
• Double-Blind Method
• Female
• Humans
• Ischemia (complications)
• Kidney Tubular Necrosis, Acute (drug therapy, etiology, mortality)
• Male
• Middle Aged
• Natriuresis (drug effects)
• Peptide Fragments (therapeutic use)
• Prognosis
• Prospective Studies
• Randomized Controlled Trials as Topic
• Renal Dialysis
• Risk Factors
• Survival Analysis