Hospital prevalence of kidney failure. Consequences and reflections for the planning of nephrology services.

Abstract

A prospective prevalence study of Renal Failure (RF) in inhospital patients (creatinine > = 1.7 mg/dl) was carried out during March 1994, in two hospitals covering well defined and mutually exclusive populations. Cases were selected by screening all urea and creatinine blood tests performed in both laboratories, and registered in an individual form for daily follow-up of their nephrologic outcome. We registered 242 RF cases among 3525 patients admitted (6.8%), with an A.R.F. prevalence of 5.2%, 46% of all patients had a serum creatinine > 3 mg/dl and 71% were older than 65 years. In 55% RF was acquired inside the hospital. The most frequent cause of A.R.F. was pre-renal failure with 37%, followed by 32% of ischemic acute tubular necrosis and 13% toxic ATN. Nephrology was consulted in only 29% of all hospital RF cases. Only 17% of the RF patients were submitted to dialysis procedures, overall mortality was 31%, and 30% had normal renal function at discharge. Our results provide a data base to rethink the organization, staffing and role of nephrology departments inside general hospitals.