Increased Prevalence and Decreased Mortality of Patients With Acute Kidney Failure

Abstract

Acute renal failure (ARF) remains one of the most enigmatic syndromes in nephrology, with reported incidence rates varying from 0.9 to 20% and mortality rates between 25 to 80% (1). There is little doubt that these discrepancies are caused by large differences in the definition of ARF (2), case-mix (3), and experience with treatment of ARF and its concomitant pathology. In this issue of JASN, two papers describe the epidemiologic and prognostic evolution of ARF over the last decade (4,5). Both papers are based on a retrospective analysis of databases containing a very large number of patients and, interestingly, covering to some extent similar patient populations. The main message of both papers is that, in contrast to other recent data (6), the death rates attributable to ARF are declining over time despite a rise in the occurrence of ARF in the same period. One study (5) is based on the US Renal Data System and covers Medicare patients who were identified by International Classification of Diseases, 9th Edition, Clinical Modification (ICD9-CM) discharge codes, while the other (4) covers a nationwide inpatient sample database of hospital discharges.