Objective: To investigate the differences between hospital-acquired acute renal failure (HA-ARF) and community-acquired acute renal failure (CA-ARF) in epidemiology, etiology and prognosis.
Methods: The diagnosis of ARF of patients diagnosed with ARF from ICD-9 codes, who were discharged from Peking University Third Hospital from January 1994 to December 2003, was reconfirmed and categorized by two nephrologists independently. The indexes of epidemiology, etiology and prognosis were studied. Single-variable analysis and multivariate logistic regression analysis were performed to investigate the correlation between clinical features and prognosis respectively.
Results: Two hundred and five cases were collected and all were reconfirmed. CA-ARF had a predominance of 59.5%. HA-ARF, however, increased by 1.06 times in last 5 years (P<0.05); 59.0% of HA-ARF was diagnosed in department of surgery while 70.5% of CA-ARF was in medical department (both P<0.05); 36.1% HA-ARF patients had two or more pathogenic causes, while 91.2% CA-ARF only had one cause (P<0.05); 49.4% HA-ARF developed after operation; 26.5% HA-ARF and 18.8% CA-ARF were drug-related (P>0.05); 24.1% HA-ARF and 12.3% CA-ARF were infection-related (P=0.028). Mortality and recovery rates were 62.7% and 20.6%, respectively, in HA-ARF while 23.0% and 67.2% in CA-ARF respectively (both P<0.01). The percentage of oliguria, multiple organ failure (MOF), systemic inflammatory response syndrome (SIRS), and use of mechanical ventilation were significantly higher in HA-ARF than in CA-ARF (all P<0.01). Acute tubule necrosis-injury severity score (ATN-ISS), acute pathological and chronic health evaluation (APACHE II) score were 0.54+/-0.24 and 19.6+/-4.9 in HA-ARF, while they were 0.27+/-0.18 and 15.7+/-5.6 in CA-ARF (both P<0.01). Multiple regression analysis identified that both MOF and SIRS were common independent risk factors for HA-ARF and CA-ARF, and oliguria and advanced age were respective independent risk factor for HA-ARF and CA-ARF.
Conclusion: CA-ARF prevails in hospitalized Chinese patients during the last 10 years, but HA-ARF is increasing in incidence significantly during the last 5 years. The etiology is mostly simple and the prognosis is relatively good in CA-ARF, while the pathogenic cause is mostly complicated and the outcome is much poorer in HA-ARF.