Abstract
During the period from 1978 to 1989, 499 patients suffering from chronic renal failure (CRF) were treated by hemodialysis (HD) in the Nagasaki Municipal Medical Center. Among these cases, 54 patients (10.8%) were diagnosed as having an acute exacerbation of CRF and were studied for this report. They were 27 males and 27 females and their mean age was 66 years.
Acute exacerbation was diagnosed by the following three criteria: 1. ongoing renal disease; 2. preexisting renal insufficiency (creatinine levels: 2.0-7.0mg/dl); 3. initiation of dialysis therapy within two months from the onset of exacerbation.
The ongoing renal disease were nephrosclerosis in 19, diabetes in 18, chronic glomerulonephritis in 7, amyloidosis in 4 and in the other 6 cases. The main causes of acute exacerbation were heart failure, dehydration, infection and anasarca.
After exacerbation, the mean creatinine level increased from 3.6mg/dl to 7.5mg/dl, but there were only 16 patients with creatinine levels higher than 8.0mg/dl, In the other cases, symptoms requiring the initiation of HD were heart failure, oliguria, electrolyte imbalance, anasarca, etc. The prognoses were maintenance of HD in 7, discontinuance of HD 12, and death in 35 (after discontinuance of HD in 10).
The patients in whom HD was discontinued were characterized by the following points: 1. younger mean age; 2. shorter duration between onset of acute exacerbation and initiation of HD; 3. decreased urine volume, lower BUN levels and a slight degree of anemia at the initiation of HD; 4. lower number of failing organs. The creatinine level, however, was not a significant prognostic indicator.
