Acute renal failure – still a killer disease

Investment in medical research is expected to have a payback; we assume that with the passage of time increased knowledge and understanding of disease process will inevitably lead to improved treatment and better outcome. This optimistic paradigm has proved valid for some of the major killer diseases, including heart disease and some common cancers. 

But for others, investment has thus far been less fruitful; acute renal failure is a case in point. The chance of surviving acute renal failure is no better today than it was 50 years ago according to the disappointing results of this study. A MEDLINE search of the literature using keywords “acute renal failure” crossed with “outcome”, “mortality”, “ICU”, “critically ill” or “prognosis” revealed 85 articles with data on acute renal failure mortality. 

The database provided details of outcome - survival or death - for nearly 16,000 acute-renal-failure victims around the world during the period 1950-2003. Three of the 85 studies revealed mortality rates of less than 30 % and in five studies mortality was > 80 %, but in most the recorded mortality was in the range 40-60 %. 

There was no detectable trend with time and the authors had to conclude that despite introduction of novel approaches in monitoring and treatment, there has been no improvement in outcome. Today, as was the case 50 years ago, around half of all patients with acute renal failure do not survive their illness.