320例急性肾功能衰竭患者的临床分析

目的 探讨急性肾功能衰竭（ARF）住院患者的病因、预后及影响预后的因素。 方法 回顾性研究我院2003年12月至2006年12月期间急性肾功能衰竭患者的临床资料。 结果 观察期间住院患者共108 744例次，其中ARF患者320例，老年ARF患者135例，占42.2%。ARF主要病因为感染、心力衰竭和药物。ARF患者总体病死率为31.9%，老年人病死率较高。Logistic回归分析显示心力衰竭、呼吸衰竭及恶性肿瘤是与预后相关的危险因素。接受肾替代治疗组患者病死率低于保守治疗组（23.2％比35.6％，P < 0.05）。 结论 住院患者中ARF的发生率、病死率高，替代治疗组预后较好。     

败血症并发急性肾功能衰竭患者的临床特点和影响预后的因素

目的：探讨败血症伴急性肾功能衰竭（ARF）患者的临床特点和影响预后的因素。方法：回顾分析近10年败血症ARF患者的临床资料，分别计算APACHE Ⅱ和ATN－ISI积分，并与非败血症ARF进行对比，运用多因素回归分析观察由败血症引起ARF的临床和主要生化指标与预后的关系。结果：败血症并发ARF者66例，占同期ARF患者的15．6％。多脏器衰竭发生率为87．9％，病死率高达69．7％。单因素分析发现外科原因的败血症、并发呼吸衰竭、肝功能衰竭、辅助呼吸、少尿、昏迷、多脏器衰竭、在ICU中出现ARF以及慢性疾病数目为影响其预后的因素。多因素logistic回归分析结果显示少尿、在ICU中出现的ARF、慢性疾病数目和多脏器衰竭为其独立危险因素。结论：败血症所致ARF患者预后差，其高病死率与少尿，在ICU中出现ARF、合并慢性疾病数目和多脏器衰竭有关。     

住院肿瘤患者急性肾损伤的发病及预后相关危险因素分析

目的:探讨住院肿瘤患者急性肾损伤(AKI)的发病及预后情况,寻找与预后相关的危险因素,为深入认识肿瘤患者AKI的病因分布及临床特点,改善肾脏及患者预后提供依据。方法:应用医院病案信息系统筛选2012年1月~12月我院住院肿瘤患者,选择病史资料完整的AKI患者组成研究队列,回顾性分析AKI的发病率、病因及分布特点、患者及肾脏预后情况。Logistic回归分析影响AKI患者预后和肾脏预后的危险因素。结果:符合入选标准的AKI患者共126例,发病率为1.05%。病因中肾前性17例,肾性102例,肾后性7例。其中肾小管间质性疾病67例,急性肾小管坏死27例,急性肾小球和肾血管病变8例。AKI患者中有40例自动出院,19例死亡,存活67例;有51例AKI患者肾功能完全恢复,21例部分恢复,而多达54例患者肾功能不恢复。经分析,AKI分期影响患者预后,分期越高死亡率越高,且合并低血压的患者死亡风险更大。单因素卡方检验提示性别、年龄、AKI分期以及低血压均与肾脏预后差异有统计学意义,但经多因素校正后仅AKI分期与肾脏预后差异有统计学意义,多因素logistic回归分析也提示相同结论。造影剂使用与否对AKI分期的影响差异无统计学意义,而使用铂类药物患者的AKI分期水平低于非铂类药物使用患者。结论:AKI在住院肿瘤患者中具有一定发生率,病死率较高。AKI后可导致患者预后变差及肾脏功能损伤。AKI分期及低血压与患者预后直接相关,而AKI分期是肾脏预后的明显危险因素。     

410例急性肾衰竭患者临床特点及影响预后的危险因素分析

目的：总结急性肾衰竭（ARF）的病因、临床特点以及影响预后的因素。方法：回顾性分析收治的410例ARF患者的临床资料及病因、病史与血常规、尿常规、肾功能、电解质、血蛋白、血气分析等影响预后因素。结果：410例ARF患者中,男275例,女135例。男∶女=2.04∶1,平均年龄（48.15±18.33）岁。ARF病因：少年组以急性肾小球肾炎等肾实质性疾病为主,中年组为急性肾衰竭发病年龄高峰,以梗阻性肾病为主,其次为肾实质性病和肝胆胰疾病。老年组病因主要见于肾病,治愈率最低（26.83%）,病死率最高（13.82%）,明显高于青年组（10.92%）和中年组（4.83%）,差异有统计学意义。单因素分析显示有无肾病史、MODS、血K^＋、Hb、HCT、Alb共6个因素是影响预后的因素。多因素Logistic回归分析显示,低血红蛋白、MODS、高血钾是影响病死率的危险因素。结论：肾后性原因导致的ARF需要引起关注。积极治疗原发病因,同时重视增加病死率危险因素纠正,尤其是MODS有助于降低ARF病死率。     

75例多发性骨髓瘤合并肾损害的临床特点及预后的分析

目的：分析75例多发性骨髓瘤（MM）并骨髓瘤肾病（MMN）临床特征及与预后的相关危险因素。方法：对75例MM病例进行随访。记录病人的临床和实验室检查结果，及合并感染或急性肾衰竭（ARF）情况。结果：初诊时肾脏累及：蛋白尿型26．7％，肾病综合征16.0％，肾衰竭型57．3％。肾综型及肾衰竭型血钙水平较蛋白尿型明显增高。肾综型易并发ARF。存活少于12个月者多为老年人、初诊合并感染及高钙血症或／和肾衰竭、发生ARF经治疗肾功能不能恢复者。化疗加血液净化可延长患者的生存时间。结论：MM合并MMN是非常常见。〉70岁、高钙血症、初诊有肾功能减退及感染、治疗后肾功能不能恢复是预后差的主要危险因素：积极化疗加血液净化治疗能改善肾功能，延长患者的生存时间。     

单中心住院患者急性肾损伤患病现况调查及预后分析

目的探讨住院患者急性肾损伤(acute kidney injury,AKI)患病及预后情况,并对预后相关的危险因素进行分析。方法通过石河子大学医学院第一附属医院检验科数据检索系统筛选出2015年1月至2015年12月所有住院患者58 444例,根据改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)发布的最新AKI临床指南中血肌酐的定义标准,对于符合的患者组成队列研究,回顾性分析住院患者AKI的患病情况,采用Logistic回归分析患者死亡和肾脏预后的危险因素。结果符合入选标准的AKI患者609例,AKI患病率1.04%(609/58 444),男、女发病比率为2.07:1,平均年龄(66.3±16.1)岁。根据KDIGO指南AKI分期标准,Ⅰ期249例(占40.9%),Ⅱ期263例(占43.2%),Ⅲ期97例(占15.9%)。导致住院患者发生AKI的原因中,肾前性原因431例(占70.6%),肾性原因131例(占21.5%),肾后性原因48例(占7.9%)。在发生AKI第7天观察时,病死率25.5%(155/609);以出院作为观察节点时,病死率29.1%(177/609);在观察患者肾脏预后中,29.9%的患者肾功能未恢复,18.7%的患者肾功能完全恢复,41.2%的患者肾功能部分恢复。多因素Logistic回归分析,年龄(OR=1.598)、AKI分期(OR=1.538)、昏迷(OR=2.659)、慢性肝脏病(OR=2.134)是患者死亡的独立危险因素。肾外脏器衰竭(P0.01,OR=2.548,95%CI:1.717~3.783)是患者肾功能未恢复的独立危险因素。结论 AKI是住院患者越来越普遍并且或将成为影响预后的严重并发症。年龄、AKI分期、昏迷、慢性肝脏病是患者死亡的独立危险因素。肾外脏器衰竭是患者肾功能未恢复的独立危险因素。     

影响肝移植术后早期急性肾功能不全相关危险因素分析

目的探讨影响肝移植术后早期急性肾功能不全的相关危险因素。方法回顾性分析我院肝移植中心2008年3月～2009年10月间资料完整的99例肝移植患者围手术期病例资料,利用回归分析方法筛选肝移植术后急性肾功能不全（ARF）的相关因素。结果手术早期ARF患者29例（29.3%）,在回归分析中患者肝移植术前血清肌酐水平是肝移植术后急性肾功能不全独立危险因素（P=0.004）;FK506日用量是术后发生ARF独立危险因素（P=0.031）;结论术前血清肌酐、术后FK506日用量是影响肝移植早期急性肾功能不全的独立危险因素。     

中性粒细胞/淋巴细胞比值与狼疮性肾炎肾功能及肾脏预后的关系

目的:探讨中性粒细胞/淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)与狼疮性肾炎(lupus nephritis,LN)患者肾功能的关系及其对肾脏预后的影响。方法:纳入93名病理证实的LN患者,根据NLR中位值(NLR=3. 175)分成高NLR组与低NLR组,比较2组之间临床、实验室及病理指标间的差异,分析NLR与eGFR之间的相关性,并通过分层及交互作用分析探讨不同指标对二者关系间的影响,利用Cox回归分析NLR对肾脏预后的影响。结果:(1)与低NLR组相比,高NLR组超敏C反应蛋白、白细胞计数、中性粒细胞、eGFR、新月体比例高,淋巴细胞计数低(均P 0. 05)。(2) NLR与eGFR呈负相关(r=-0. 278,P=0. 007)。(3)多重线性回归分析得出NLR是eGFR的独立危险因素(β=-1. 96,P=0. 029)。(4)亚组分析发现在高白细胞组或低LDL组患者中,NLR是eGFR独立影响因素(均P 0. 05),而在低白细胞组或高LDL组患者中,NLR与eGFR关系不具有统计学意义(均P 0. 05)。其余分组未影响二者间关系。(5)单因素Cox回归分析结果提示NLR为LN患者肾脏预后的危险因素(HR=1. 11,P=0. 047),但多因素Cox回归分析未发现NLR对LN患者预后的独立影响作用。结论:NLR与LN患者肾功能水平独立相关,且NLR与肾功能的独立关系受白细胞计数及LDL水平影响。此外,NLR水平是肾脏预后不良的危险因素,尚需进一步扩大样本量探讨NLR是否为肾脏预后的独立危险因素。     

568例基层医院急性肾衰竭患者病因及其危险因素分析

目的：分析基层医院急性肾衰竭（ARF）的病因,寻找影响其预后的危险因素,为降低ARF发病率,提高临床疗效,判断预后提供参考。方法：以2007年6月～2009年6月就诊于温岭市第一人民医院等4个基层医院的ARF患者为研究对象,归纳引起ARF的病因;将其分为治愈组、好转组、无效组和死亡组,首先采用单因素分析方法初步筛查出危险因素,然后将初筛的危险因素进一步使用二分类Logistic回归法做多因素分析,判别各因素对死亡危险度的影响。结果：（1）301224例住院患者中,ARF患者568例（占0.19%）;其中男366例（占64.45%）,女202例（占35.56%）,男女之比1.8∶1。（2）568例ARF患者中,按照肾性、肾前性和肾后性分类方法,以肾性ARF最常见,共282例（占49.65%）,肾前性ARF140例（占24.65%）,肾后性ARF146例（占25.70%）。按照引起ARF的原因分类,肾实质损害和梗阻所占比例最大,分别为22.89%和21.65%,其次是感染和药物因素,分别占11.97%和9.15%。（3）多脏器功能衰竭（MODS）、高血钾及贫血是导致ARF预后差的危险因素。结论：ARF发病率为0.19%,男性多于女性,除肾原性原因外,肾后梗阻、感染和药物性肾损害是最常见原因。MODS、贫血、高血钾是影响预后的危险因素。     

内科住院患者急性肾损伤的临床特征与预后分析

目的探讨内科住院患者急性肾损伤(AKI)的临床特征。方法收集上海长征医院2011至2012年度内科住院患者的肾功能指标,根据2012年KDIGO的AKI诊断标准筛选出符合标准的AKI患者,回顾性分析其临床资料,探讨其临床特征和预后影响因素。结果 2011年1月至2012年12月长征医院内科住院患者共33 332例,符合入选标准的AKI患者共245例,AKI发病率为0.74%,识别率为35.92%。AKI 1~3期患者所占比例分别为42.45%、20.41%和37.14%。在所有内科科室中,构成比最高的科室为肾脏内科(33.47%),其次为心血管内科(20.00%)、消化内科(11.84%)和感染科(10.61%)。AKI发病率由高至低依次为感染科(1.70%)、肾脏内科(1.37%)、心血管内科(1.11%)。所有AKI住院患者中,有71.84%患者好转出院,其中仅34.69%的患者肾功能完全恢复,28.16%的患者死亡或放弃治疗。病死率较高的科室依次为感染科(占21.74%)、消化内科(20.29%)和心血管内科(17.38%)。感染是引起内科住院患者AKI的主要因素。Logistic回归分析提示AKI分期高、高危因素多、合并肝脏疾病或肿瘤是患者死亡及放弃治疗的危险因素,而合并慢性肾脏病是其保护性因素;AKI分期高与合并肝脏疾病是患者肾功能未恢复的危险因素。结论 AKI在内科系统中较为常见,其发病率高、识别率低。除了肾脏内科外,心血管内科、感染科、消化内科是AKI负担较重的科室。AKI分期高、高危因数多、合并肝脏疾病与肿瘤是不良预后的危险因素。     

Prediction of outcome in acute renal failure

In an attempt to predict outcome in acute renal failure (ARF) we have utilized multiple logistic regression to analyze clinical data from 151 patients with ARF seen over a 15-month period. Recovery of renal function occurred in 60% of patients with a 58% survival. Our analysis demonstrated sepsis, respiratory failure, and oliguria to be the major predictors of nonrecovery of renal function. A logistic equation was generated for prediction of outcome and was validated in a second independent group of patients with ARF. Prediction of outcome could be achieved with a sensitivity of 75% and a specificity of 80%. Maximum sensitivity (100%) was associated with a 17% specificity, while maximum specificity (98%) yielded a sensitivity of 20%.     

Mortality after acute renal failure: models for prognostic stratification and risk adjustment

To adjust adequately for comorbidity and severity of illness in quality improvement efforts and prospective clinical trials, predictors of death after acute renal failure (ARF) must be accurately identified. Most epidemiological studies of ARF in the critically ill have been based at single centers, or have examined exposures at single time points using discrete outcomes (e.g., in-hospital mortality). We analyzed data from the Program to Improve Care in Acute Renal Disease (PICARD), a multi-center observational study of ARF. We determined correlates of mortality in 618 patients with ARF in intensive care units using three distinct analytic approaches. The predictive power of models using information obtained on the day of ARF diagnosis was extremely low. At the time of consultation, advanced age, oliguria, hepatic failure, respiratory failure, sepsis, and thrombocytopenia were associated with mortality. Upon initiation of dialysis for ARF, advanced age, hepatic failure, respiratory failure, sepsis, and thrombocytopenia were associated with mortality; higher blood urea nitrogen and lower serum creatinine were also associated with mortality in logistic regression models. Models incorporating time-varying covariates enhanced predictive power by reducing misclassification and incorporating day-to-day changes in extra-renal organ system failure and the provision of dialysis during the course of ARF. Using data from the PICARD multi-center cohort study of ARF in critically ill patients, we developed several predictive models for prognostic stratification and risk-adjustment. By incorporating exposures over time, the discriminatory power of predictive models in ARF can be significantly improved.     

Prediction of mortality in acute renal failure in the tropics

Despite significant improvements in medical care, acute renal failure (ARF) remains a high risk for mortality. It is important to be able to predict the outcome in these patients in view of the emotional and ethical needs of the patients and to address questions of efficiency and quality of care. We analyzed the risk factors predicting mortality prospectively in a group of 265 patients using univariate and multiple logistic regression analysis. A prognostic model was evolved that included 10 variables. The model showed good discrimination [(receiver operating characteristic (ROC) area=0.91) and correctly classified 88.30% of patients. The variables significantly associated with mortality were coma odds ratio (OR)=9.8], oliguria (OR=4.9), jaundice (OR=3.7), hypotension (OR=3.1), assisted ventilation (OR=2.3), hospital acquired ARF (OR=2.3), sepsis (OR=2.2), and hypoalbuminemia (OR=1.7). Age and male gender were included in the model as they are clinically important. The score was validated in the same sample by boot strapping. It was also validated in a prospective sample of 194 patients. The model was calibrated by the Hosmer-Lemeshow goodness-of-fit test. It was compared with two generic illness scores and one specific ARF score and was found to be superior to them. The model was verified in different subgroups of ARF like hospital acquired, community acquired, intensive care settings, nonintensive care settings, due to sepsis, due to nonsepsis etiologies, and showed good predictability and discrimination.     

Risk factors for development of acute renal failure after liver transplantation

BACKGROUND: Acute renal failure (ARF) is a common complication after liver transplantation (LTx). Identification of risk factors may prevent the development and attenuate the impact of ARF on patients outcome after LTX. METHODS: Retrospective analysis of variables in the pre, intra, and postoperative periods of 92 patients submitted to LTx was performed in order to identify risk factors for development of ARF after LTx. ARF was defined as serum creatinine > or = 2.0 mg/dL in the first 30 days after LTx. Univariate and multivariate analysis by logistic regression were performed. RESULTS: ARF group comprised 56 patients (61%). Preoperative serum creatinine was higher in ARF group. During the intraoperative period, ARF group required more blood transfusions, developed more episodes of hypotension and presented longer anesthesia time. In the postoperative period, ARF group presented higher serum bilirubin and more episodes of hypotension. Dialysis was required in 10 patients (11%). The identifled risk factors for development of ARF were: preoperative serum creatinine > 1.0 mg/dL. more than five blood transfusions in the intraoperative period, hypotension during intra and postoperative periods. The identified mortality risk factors were hypotension in the postoperative period and no recovery of renal function after 30 days. CONCLUSIONS: Several factors are involved in the pathogenesis of ARF after LTx and may influence patients outcome and mortality. Pretransplant renal function and hemodynamic conditions in the operative and postoperative periods were identified as risk factors for development of ARF after LTx. Nonrenal function recovery and postoperative hypotension were identified as mortality risk factors after LTx.     

Influence of underlying disease on the outcome of critically ill patients with acute renal failure

BACKGROUND AND OBJECTIVE: The development of acute renal failure (ARF) in critically ill patients is associated with an increase in hospital mortality. Recently, it was shown that starting renal replacement therapy early and using high-filtrate flow rates can improve the outcome, but this could not be confirmed in later investigations. Studying selected patient subgroups could provide a useful basis for patient selection in future trials evaluating the outcome of renal replacement therapies. We, therefore, investigated the impact of the underlying disease on the outcome of patients with ARF. METHODS: We retrospectively analysed 306 patients with ARF who were treated with renal replacement therapy. Patients were classified according to six initial diagnosis groups: haemorrhagic shock, post-cardiac surgery, post-liver transplantation, trauma, severe sepsis and miscellaneous. Univariate and multivariate multiple logistic regression analysis was used to determine which factors influenced the outcome. RESULTS: Underlying disease proved to be the only independent risk factor for mortality that was present at intensive care unit (ICU) admission (P = 0.047). Patients with severe sepsis had a significantly higher mortality rate (68%) than ARF patients as a whole (51%) (P = 0.02). Length of stay in the ICU, the use of catecholamines, the delay before ARF onset, and the correlation between APACHE II score and ICU length of stay proved to be additional independent predictors of outcome. CONCLUSIONS: Patient selection and subgroup definition according to the underlying disease could augment the usefulness of future trials evaluating the outcome of ARF.     

Etiology, prognosis, and outcome of post-operative acute renal failure

A Multivariate analysis was done in all patients who developed post operative ARF, during the period 1990-1995 to determine the etiological spectrum and to identify various variables affecting the outcome. Of 140 patients (110 operated at SGPGI and 30 operated outside) 116 underwent elective surgery. The different types of surgery leading to ARF were urosurgery (3.5%), open heart surgery (32.9%), gastrosurgery (16.4%), pancreatic surgery (9.3%), obstetrical surgery (3.6%) and others (2.8%). The incidence of ARF in SGPGI patients was highest in pancreatic surgery group (8.2%) followed by open heart surgery (3%). The different etiological factors responsible for ARF were perioperative hypotension (67.1%), sepsis (63.6%) and exposure to nephrotoxic drugs (29.3%). Sixty-four patients (45.7%) required dialysis. The overall mortality was 45%. The mortality was highest in patients who underwent open heart surgery (89.1%) followed by pancreatic surgery (84.6%). The factors associated with high mortality, other than the type of surgery, were preoperative hypotension (p < 0.05), oliguria (p < 0.01), need for dialysis (p < 0.05) and multiorgan failure (p < 0.001). AM following emergency surgery had poor outcome, though not statistically significant. Perioperative sepsis (p < 0.05) and preoperative use of aminoglycoside (p < 0.05) were significantly higher in patients operated outside SGPGI. This was associated with higher incidence of ARF. Thus we conclude that presence of multiorgan failure, oligoanuria, preoperative hypotension and need far dialysis are poor prognostic markers in ARF following surgery.     

Factors associated with mortality in acute renal failure (ARF) in children

Objective: To assess the factors that affect the mortality in acute renal failure (ARF) in children. Patients and methods: We studied 149 patients with ARF and described the findings by age, gender, pathophysiological mechanism of renal damage, and type of renal damage, which can be oligoanuric and/or septic. We used multiple logistic analysis, Cox analysis for survival, and Kaplan–Meier curves. Results: The male/female ratio was 91/58. The most affected age groups were newborns (44.3%) and infants (37.6%). The ARF mechanism was ischemic in 87 cases (58%) and the most frequent clinical type was nonoliguric in 118 cases (79.2%). In the multiple logistic regression analysis, only oliguria (P=0.07) and age group (P=0.049) were associated with mortality. In the survival analysis using the Cox method, oliguria (P=0.003) and sepsis (P=0.03) were associated with mortality. The survival curves showed that the cumulative probability of dying in the first 10, 20, or 40 days after the event was 75, 70, and 45% respectively. When oliguria was present, the survival at day 10 was 47% and when sepsis was present it was 68%. Conclusion: Oliguria, age, and sepsis are factors associated with mortality in children with ARF.     

Predictors of mortality in acute renal failure in a developing country: a prospective study

Acute renal failure (ARF) occurs in wide range of conditions, making the evaluation of its prognosis a difficult task. Data regarding prognostic factors in ARF in a general population in developing countries are scarce. The objective of the study was to describe predictors of mortality in ARF that are relevant in the developing world. This prospective study was carried out over a one-year period; all hospitalized adults with ARF were included in the study. Predictors of mortality studied included causes of ARF, pre-existing diseases, and severity as well as complications of ARF. Of 33,301 patients admitted during the study period, 294 (0.88%) were either admitted with or developed ARF after hospitalization. Mean age was 43.9 +/- 16.9 (18-86 yrs). Sepsis was the most common cause (63.26%). Pre-existing diseases like cardiovascular disease (CVSD), respiratory system disease (RSD), central nervous system disease (CNSD), hypertension, diabetes mellitus (DM), and malignancy were significantly higher in elderly as compared to younger patients. On univariate analysis sepsis, hypoperfusion as a cause of ARF and hospital-acquired ARF were associated with higher mortality. Pre-existing diseases viz. RSD, CVSD, CNSD, and DM had higher mortality. Among the severity and complications of ARF, oliguria, bleeding and infection during the course of ARF and critical illness were predictors of poor outcome. Age > 60 yrs was associated with significantly higher mortality. However, on multivariate analysis, only critical illness (odds ratio 37.3), age > 60 years (odds ratio of 5.6), and sepsis as cause of ARF (odds ratio of 2.6) were found to be independent predictors of mortality.     

Predictors of Mortality in Acute Renal Failure in a Developing Country: A Prospective Study

Acute renal failure (ARF) occurs in wide range of conditions, making the evaluation of its prognosis a difficult task. Data regarding prognostic factors in ARF in a general population in developing countries are scarce. The objective of the study was to describe predictors of mortality in ARF that are relevant in the developing world. This prospective study was carried out over a one-year period; all hospitalized adults with ARF were included in the study. Predictors of mortality studied included causes of ARF, pre-existing diseases, and severity as well as complications of ARF. Of 33,301 patients admitted during the study period, 294 (0.88%) were either admitted with or developed ARF after hospitalization. Mean age was 43.9 ± 16.9 (18–86 yrs). Sepsis was the most common cause (63.26%). Pre-existing diseases like cardiovascular disease (CVSD), respiratory system disease (RSD), central nervous system disease (CNSD), hypertension, diabetet mellitus (DM), and malignancy were significantly higher in elderly as compared to younger patients. On univariate analysis sepsis, hypoperfusion as a cause of ARF and hospital-acquired ARF were associated with higher mortality. Pre-existing diseases viz. RSD, CVSD, CNSD, and DM had higher mortality. Among the severity and complications of ARF, oliguria, bleeding and infection during the course of ARF and critical illness were predictors of poor outcome. Age >60 yrs was associated with significantly higher mortality. However, on multivariate analysis, only critical illness (odds ratio 37.3), age > 60 years (odds ratio of 5.6), and sepsis as cause of ARF (odds ratio of 2.6) were found to be independent predictors of mortality.