Prognosis of acute renal failure in the elderly

Life expectancy is uncertain in the elderly with ARF. In orderto determine whether a costly supportive management is worthwhile,we have studied a group of 68 elderly patients (over 65 yearsof age) admitted to the ICU with ARF. Patients: 47 male; 21 female; 72 ± 6 years old. Types of ARF include prerenal 24; obstructive 9; intrinsic 35(acute tubular necrosis 30; glomerulo-nephritis 4; vascular1). The mean simplified acute physiology score (SAPS) was 14±4;39 patients (57.3%) had more than two underlying diseases; 42patients (61.7%) were on mechanical ventilation; 40 patients(60%) underwent haemodialysis. The overall survival rate was 36.7%. Among the parameters studied,organic systemic failure index (OSF), diuresis, blood lactate,systolic blood pressure, urea appearance rate (UAR), differedsignificantly in survivors and deceased. From these resultswe conclude that the elderly with non-oliguric ARF, normal bloodlactate, low catabolic state, and no more than two organ failureshave a fair chance of recovering and should therefore be treatedaggressively. In other cases, decisions to proceed with intensivesupportive measures should be made according to individual characteristics.