Acute renal failure in hospitalized patients: part I

BACKGROUND: Acute renal failure (ARF) is a common condition in hospitalized patients. Morbidity, mortality, and health resource use are considerable, but the true magnitude of the problem is not well described in the literature. OBJECTIVE: To provide a detailed discussion of the epidemiology, economic costs, and classification of ARF. DATA SOURCES: A MEDLINE search (1996-December 2001) was conducted using the search terms kidney and acute kidney failure: epidemiology, etiology, and drug therapy/drug effects. Bibliographies of selected articles were also examined to include all relevant investigations. Economic data were identified using the terms costs and cost analysis and cost of illness. STUDY SELECTION AND DATA EXTRACTION: Review articles, meta-analyses, and clinical trials describing epidemiology and classification of hospital-acquired ARF were identified. Results from prospective, controlled trials were given priority when available. CONCLUSIONS: ARF occurs in up to 25% of critically ill patients, resulting in significant morbidity and high mortality. Characterization of ARF is difficult due to multiple etiologic factors and variable definitions. Limited cost data describe the extensive economic burden associated with the disorder, although further pharmacoeconomic research is needed. Epidemiology and classification of ARF allow prospective management of at-risk patients.