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Acute renal failure in severely burned patients

2007; Elsevier BV; Volume: 73; Issue: 2 Linguagem: Inglês

10.1016/j.resuscitation.2006.10.029

1873-1570

José António Lopes, Sofía Jorge, Fernando Neves, Antônio Gomes da Costa, Mateus Martins Prata, Manuel Caneira, Acácio Cordeiro Ferreira,

Restraint-Related Deaths

Acute renal failure (ARF) is a common and potential life-threatening complication in the burned patient.1Bang R.L. Sharma P.N. Gang R.K. Ghoneim I.E. Ebrahim M.K. Burn mortality during 1982 to 1997 in Kuwait.Eur J Epidemiol. 2000; 16: 731-739Crossref PubMed Scopus (19) Google Scholar, 2Anlatici R. Ozerdem O.R. Dalay C. Kesiktas E. Acarturk S. Seydaoglu G. A retrospective analysis of 1083 Turkish patients with serious burns. Part 2. Burn care, survival and mortality.Burns. 2002; 28: 239-243Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar, 3Kim G.H. Oh K.H. Yoon J.W. et al.Impact of burn size and initial serum albumin level on acute renal failure occurring in major burn.Am J Nephrol. 2003; 23: 55-60Crossref PubMed Scopus (72) Google Scholar We evaluated retrospectively the incidence of ARF (defined as a doubling of baseline serum creatinine), associated risk factors, therapy and outcome of patients with severe burns admitted in the Burns Unit of our hospital between January 2004 and June 2006. The Parkland formula was used to calculate the volume of fluid to give. One hundred and twenty-six patients (83 men; mean age: 49.4 ± 19.2 years; 123 Caucasian; 10 diabetic) were evaluated. Acute renal failure occurred in 32 patients (25%). Age (59.9 ± 18 years versus 45.9 ±18.4 years; P = 0.0001) and mean burned body surface (43.9 ± 28.4% versus 17.9 ±15.6%; P = 0.0001) was higher in ARF patients while serum albumin was lower (23.5 ± 5.9 g/L versus 30.9 ± 5.9 g/L; P = 0.0001). Hypovolaemia (n = 31), septic shock (n = 23) and rhabdomyolysis were the most common conditions associated with ARF. Dialysis-dependent ARF occurred in 11 patients (34%) and venovenous continuous hemodiafiltration was performed in all cases. Twenty-six patients (22 with ARF; P = 0.0001) died. In conclusion, the incidence of ARF among burned patients remains unacceptably high and is associated with a poorer outcome. Hypovolaemia remains the main pathophysiological condition. Age, burned surface area and hypoalbuminaemia are the main predisposing factors to ARF in the burned patient. Despite multiple fluid resuscitation strategies a more precise estimation of fluid volume deficit seems desirable.