Despite advanced techniques of
renal replacement therapy as well as improved medical care and control over the last decade, the overall mortality of patients with "internal" nontraumatic
acute renal failure (ARF) requiring replacement
therapy is still high. In a retrospective study we compared causes of nontraumatic ARF, risk factors for the development of
renal failure and mortality rates in patients with nontraumatic ARF, who received
hemodialysis therapy from 1981 to 1990 and from 1991 to 2000. 510 patients with nontraumatic ANV requiring
hemodialysis were evaluated, 278 patients in 1981-1990 and 232 patients in 1991-2000. In both groups the chronic risk factors for ANV such as
hypertension,
diabetes mellitus, chronic
cardiac failure, chronic
hepatic failure and pre-existing renal impairment and the causes of a traumatic ARF were compared. In addition, concomitant
sepsis and multi-organ failure as prognostic parameters as well as mortality rates dependent on the causes of ARF were evaluated. In the latter period, there was a significant reduction in the prevalence of acute
glomerulonephritis (3.0 versus 8.3%, p < 0.05) and acute
interstitial nephritis (2.6 versus 7.6%, p < 0.05) as well as
acute pancreatitis (1.7 versus 7.6%, p < 0.01) as causes of ARF. On the other hand, the prevalence of
drug-induced ARF increased during the latter period (10.8 versus 4.7%, p < 0.05). Other etiologies of nontraumatic ARF did not significantly differ between the two decades. Patients treated from 1991 to 2000 had chronic risk factors for the development of ARF, namely diabetes (14.6 versus 6.8%),
coronary artery disease (28.0 versus 9.3%) and pre-existing renal impairment (51.7 versus 17.6%, p < 0.001), more frequently than did patients dialysed from 1981-1990. The prevalence of
sepsis and multi-organ failure was approximately the same in both periods. The overall mortality (41.8 versus 44.6%, NS) and mortality secondary to causes of nontraumatic ARF were similar in both periods. In summary: the prevalence of several causes of nontraumatic ARF has changed during the last decades. Furthermore, patients treated in the 90's had chronic risk factors for
renal failure, namely diabetes and pre-existing renal impairment as well as
coronary artery disease, more frequently than did subjects treated in the preceding time period. The prognosis of the patients has not been significantly improved.