Impact of Chronic Comorbidity and Malnutrition on the Outcome of Severe Acute Renal Failure (ARF) Requiring Continuous Renal Replacement Therapy (CRRT)

초록

Recent studies indicated that malnutrition may be an adverse factor of ARF outcomes. Underlying comorbidities also can be another adverse factors of ARF. We have evaluated impact of coexistent comorbidities and nutritional state on the outcome with the patients with severe ARF. APACHE II score and number of coexistent comorbidities (among 12 acute and 8 chronic comorbidities) were evaluated as comorbidity indexes. Body mass index (BMI), serum albumin and cholesterol, subjective global assessment (SGA), protein catabolic rate (PCR), and creatinine index (CI) were evaluated as nutritional parameters. PCR and CI were calculated from urea generation rate and cr production rate that were measured prospectively during the early 12 to 24 hours of CRRT. Logistic regression analysis revealed that the factors contributed independently to the survival were SGA class of C (A=well-, B=moderately-, C= mal-nourished; Hazard ratio 3.5), number of chronic comorbidity 3 (1.9), CI <11 gm/kg/d (1.8), BMI < 20.0 kg/m2 (1.4) (P<0.01). In Log Rank test, survival rate was significantly decreased in the subjects with SGA class C, Cr index <11 gm/kg/d, number of chronic comorbidity 3 (P<0.001). In conclusion, malnutrition and coexistence of chronic comorbidities contibuted adversely to the survival rate of severe requiring CRRT.