The long-term outcome after acute renal failure

PURPOSE OF REVIEW: Research priorities in critical care are increasingly focusing on long-term outcomes and prognosis for survivors of critical illness. This review will focus on long-term outcomes after acute renal failure. RECENT FINDINGS: Few studies have described the long-term outcomes after acute renal failure. Rates of survival are variable and range from 46 to 74%, 55 to 73%, 57 to 65% and 65 to 70% at 90 days, 6 months, 1 year and 5 years, respectively. All of older age, co-morbid illness, illness severity, septic shock, and renal replacement therapy after cardiac surgery have been associated with reduced survival. Recovery to independence from renal replacement therapy is expected in 60-70% of survivors by 90 days. Health-related quality of life is generally good and perceived as acceptable. Survivors often experience difficulty with mobility and limitations in activities of daily living. Renal replacement therapy is costly and achieves marginal cost-effectiveness in terms of quality-adjusted survival for those with a higher probability of survival. SUMMARY: The long-term survival after acute renal failure is poor. Yet, most survivors recover sufficient function to become independent from renal replacement therapy. While perceived health-related quality of life is good, survivors have a lower health-related quality of life compared with the general population. Further research is needed to explore the relationship between survival, markers of morbidity and costs after acute renal failure.