Prognosis of chronic renal failure. II. Factors affecting survival.

After serum creatinine levels exceeded 10mg/100ml, median survival was 55 days (to death or dialysis) in a group of 112 patients with chronic renal disease. Renal failure was partially reversible in 29 patients, partially accounting for prolonged survival. Those with polycystic kidneys, pyelonephritis, or obstructive nephropathy survived longer,partially because of more frequent reversibility and a slower increase in serum creatinine concentration. Kiabetic nephropathy, myelomatous kidneys, and amyloidosis were associated with shorter survival, less frequent reversibility, and more rapid progression. Urinary infection and extracellular volume depletion often accounted for partially reversible renal failure and prolonged survival. Blood pressure and age were not prognostic variables, while coexistent heart failure shortened survival. Survival correlated significantly with sodium excretion.

Prognosis of chronic renal failure. III. Survival after one peritoneal dialysis.

Survival after serum creatinine exceeded 10.0 mg/100 ml was increased if one peritoneal dialysis was performed. After one peritoneal dialysis 'survival' of 62 patients to the present time, death or the next dialysis averaged 119 days; median survival was 28 days. Characteristics of prolonged survivors were persistent reduction of serum creatinine below the predialysis concentration, tubulointerstitial diseases, i.e. polycystic kidneys, pyelonephritis or obstructive nephropathy, potentially reversibel complications such as urinary tract infection or extracellular volume depletion, and high urine volume, and low blood pressure. Occasional pateints with survival exceeding 2 years suggest the possibility of prolonged benefit after a single dialysis at least in those wiht characteristics favoring longer survival.