Acute Renal Failure in the Surgical Intense Care Units - NTUH-SICU-ARF (NSARF) Study
Acute Renal Failure in the Surgical Intense Care Units - NTUH-SICU-ARF (NSARF) Study
We examine the prognosis and etiology of postoperative acute renal failure
Postoperative acute renal failure is a serious complication resulting in a prolonged stay and
 high mortality. Acute renal failure (ARF) develops in 5 to 30% of patients who undergo
 surgery, and for all causes, it is associated with mortality rates of 60-90%. Despite
 advances in supportive care and innovations in renal replacement therapies over the past
 three decades, the mortality rate for these patients remains high. In the previous analysis
 of NSARF (National Taiwan University Hospital-Surgical Intense Care Unit- acute renal failure
 database), the mortality rate of acute renal failure patients in SICU is 66.4%, dialysis
 dependent rate after ARF is 5% and renal recovery rate is 28.6%. Therefore, the issue
 concerned is to increase the survival rate and renal recovery rate after acute renal failure.

 Perioperative ischemic reperfusion injury may result in acute renal failure (ARF), from which
 patients can invariably recover. However, there remains a large number of patients whose
 kidneys fail to recover from ARF, and therefore long-term dialysis is required. The
 dys-regulation of the inflammatory response in critically ill patients has been implicated as
 an important mechanism underlying the development of multiple organ system dysfunction,
 septic shock, and death. Furthermore, an increase in oxidative stress is considered an
 important pathogenic mechanism in the development of ischemic and toxic renal tubular injury.
 We hypothesize that extensive immune dys-regulation and increased oxidative stress might be
 an important factor leading to ARF, and/or associated with their all-cause mortality in
 critically ill patients.

 In this study, we will find out (1) first year, the relationship between cytokine storm and
 free radical storm with urine output during post-surgical ARF, and the effect of renal
 replacement therapy on serum cytokines and free radical level (2) 2nd year, the difference
 outcome between low low-efficient daily dialysis (SLEDD), and low low-efficient daily
 dialysis-hemofiltration (SLEDD-f), the pharmacokinetics of the SLEDD (3) the 3rd year, we
 sill established the disease severity score of post-operative ARF patients. (NSARF score) and
 focus on long-term outcomes for survivors of postoperative ARF. From diagnosis to prognosis,
 we will incorporate important markers of disease diagnosis, treatment and long term outcome.
 Finally, we hope to improve the mortality and the life quality of postoperative ARF.
Inclusion Criteria:

 -  Postoperative acute renal failure

 Exclusion Criteria:

 -  Patients with ECMO or IABP