Study Critique: Acute Renal Failure in Critically Ill Patients

Introduction

According to Coughlan et al. (2007), it is crucial to critique the literature in spite of the fact that the evidence seems to be reputable. Specifically, the time changes and new information overshadows the former. The sole aim of critiquing is to vividly highlight various points of a problem that ought to be studied, offer an investigation of the whole research process, and also provide more relevant information on one or more perspectives of research procedure that can be vital to other interested researchers (Polit & Beck, 2008). The research to be critiqued is “Acute Renal Failure in Critically Ill Patients” which was carried out by Uchino (2005) et al.

Abstract

The study’s abstract provides a succinct overview of the research. It outlined information about the objectives of the study, main outcome measures, design, setting, and patients (Uchino et.al, 2005). However, the abstract fails to include brief information about the sample size and the participants’ selection process. This part of the article also lacks background information on the subject matter. Nevertheless, by going through the abstract, it was easy for me to be interested in the study since it highlighted a concise overview of the whole document giving a brief idea of the contents of the research.

Hypothesis/Aim/Objective

It is crucial to consider the aim or objective whenever one is critiquing a research study and find out if the research design fits the research articles (Coughlan et al., 2007). This factor helps in distinguishing academic articles and non-academic ones. In this study, the scholars pointed out 3 objectives that lacked a clear linkage to research questions (Uchino et al., 2005). None of the objectives is specified as being primary to the study. These objectives are 1) to determine prevalence time of acute renal failure (ARF) among patients in the intensive care unit (ICU) in various countries, 2) to characterize disparities in clinical practice (etiology and illness severity, 3) to determine the consequences of these disparities on patients (Uchino et al., 2005). The definition of terms was not provided by the researchers and this made it difficult to identify the findings and the general understanding of the study.

Sample Size

The sample size is vital in any study and ought to be assessed in relation to the concerned population (Coughlan et al., 2007). The group of researchers in this study has pointed out that the sampled population target was about 1,738 patients from 54 centers in 23 countries (Uchino et al., 2005). The patients involved in the study were more than 12 years of age and had to be admitted in one of the ICU centers under the study. The participants were further reduced to accommodate only those treated with renal replacement therapy (RRT). ARF was defined as an output of below 200ml of urine within 12 hours. This method was used on the premise that it is mathematically identifiable, objective and simple (Uchino et al., 2005). The researcher gave neither the specific number of participants involved nor mentioned whether there was compensation to the participants.

Design of the Study/Study Level

The prospective observational study was the design utilized by the researchers and information recorded in a well-developed, standardized form. A possible choice of 7 factors considered as contributing to ARF was identified and, in every case, more than one selection could be made. Data collection was performed electronically based on the excel tool which was availed under instructions to the sampled centers (Uchino et al., 2005). The data were then correctly entered and emailed to the focal center where specialists of intensive care would critically screen details to check for logical errors, omitted or inadequate information. Any query was to be solved within 2 days.

Instruments

The instruments (survey) used by the researcher were observation, reading and recording (Uchino et al., 2005). The research involved the observation of the patients’ conditions to be able to know whether their illness was acute, and thus, be admitted to the ICU where they were recruited in the sample population (Uchino et al., 2005). Upon admission, the patients’ details were carefully read and recorded in a specially prepared form.

Statistical Analysis/Results

The analysis used by the researchers is a multivariable logistic regression in which hospital mortality risk factors were investigated. The data were presented in terms of interquartile range and median as well as a percentage (Uchino et al., 2005). Bodyweight, size, and type of hospital, age, size and type of ICU, urea’s nitrogen percentage during ICU admission are among independent factors of risk investigated through the backward elimination method. P<.05 value was taken as statistically significant and all the variables that yielded that value were considered in the model. RRT mode was not regarded as a variable since the patients admitted to receiving RRT had been included (Uchino et al., 2005). The results showed that, in 23 countries, 2 centers did not give the ICU admission data, and thus, were excluded from the calculations (Uchino et al., 2005). Median screening duration at every study center was recorded as IQR, 131 to 215 days (Uchino et al., 2005).

To determine the prevalence time of ARF among patients in the ICU in various countries in light of the first objective, prevalence range was established between 1.4% and 25.9% throughout all the centers of study (Uchino et al., 2005). Out of all the ARF patients documented via the criteria of the study, RRT was used to treat 1,260 (4.3%; 95% CI, 4.2%-4.3%), while the other group of 479 (1.7%; 95% CI, 1.3%-1.6%) had ARF but RRT was not used as a way of treatment (Uchino et al., 2005).

In regard to the second objective, to characterize disparities in clinical practice, etiology and illness severity, patients with ARF median age stood at 67 (IQR, 52-76 years). 48 (IQR, 39-62) was the median score of SAPS II (Uchino et al., 2005). The chronic condition of the renal dysfunction among the patients who were not under dialysis was approximated to 31%. ICU admission creatinine clearance was estimated to be (IQR, 21-58 mL/min) (0.58 mL/s; IQR, 0.34- 0.98 mL/s). Among the patients treated by use of RRT, 81% were continuous RRT, 16.9% were recorded as intermittent, while slow continuous infiltration and peritoneal dialysis stood at 3.2%. Major ICU patients’ admission premise was medical and 41.1% cardiovascular surgery (Uchino et al., 2005).

For the third objective, to determine the consequences of these disparities on patients, 43% of the entire ARF patients succumbed to the ICU, while another 9% passed on while in hospital after being released from the ICU (Uchino et al., 2005). In terms of table 3, this represented a mortality of 61.3% (94% CI, 57.0%- 61.6%), while predicted mortality for SAPS II was 45.7% (P<.001).

Conclusion

The study findings are valuable whereas the research has investigated ARF at an international level (Uchino et al., 2005). There is a logical flow of information and the process used in the exploration of the evidence. The prevalence period among the centers varied to an almost similar extent (1.4%-29.5%), even though a single set of criteria was used. 6% is the approximated prevalence period of the ARF critically ill patients around the globe as deduced by the investigation conducted in 54 centers from 23 countries. On the other hand, the acute RRT prevalence period is lower as it is approximated to be only 4%. However, the comparison among the countries was not possible because the centers sampled could not be considered the true representation of the entire country. The most common contributing factor to ARF was septic shock and it led to nearly 50% of all cases in a significantly large number of centers. Based on findings, the statistics for the most ARF survivors was 86% and independent of dialysis upon discharge from the hospital. This number is relatively higher as compared to the 65% of the United States patients who are considered to be dialysis-free after hospital discharge (Uchino et al., 2005).

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Quality of the Study

The study was practical as it provided factual evidence from the real patients. The flow of the study is logical and the information was used comprehensively. Despite the research study being conducted in numerous countries and involved a wide range of centers, it managed to give the crucial investigation results and calculations across all the centers. The study answered all the objectives put forth through a well-outlined data collection and evaluation procedure. One of the limitations discovered in the study was that the centers chosen in a certain country were not likely to be a representation of the whole population. Therefore, this issue could be tantamount to bias in the study since centers were selected based on a certain interest. Secondly, the study was not a randomized controlled trial but an observational study and yet did not include important variables, such as mode and diagnosis of hospital admission. Thirdly, in regard to Brochard et al. (2010), proper consensus on the definition of the interest understudy is crucial, but this study lacked the definition of acute ARF and clinicians found it hard to categorize the required threshold. Fourthly, there was database limitation due to the lack of independent validation, notwithstanding the fact that the system used a 99% efficiency electronic compilation. Finally, the study failed to keep track of the patients upon hospital discharge. For this reason, the scholars failed to investigate whether the survivors lived to see another calendar year or they died after a short while.