To the Editor.—We read with interest the article by Shen and Zhang in the October 1987 issue of the Archives. Indeed the mortality of acute renal failure (ARF) remains high despite all the diagnostic and therapeutic advances of the last three decades. Sepsis and cardiovascular and pulmonary complications are poor prognostic indicators, and pulmonary involvement probably has the single most adverse prognostic influence on survival. Advanced age is believed to be a risk factor by some and not by others. Review of six recent reports2-7 dealing with ARF shows a mortality of 51.5%.
We dialyzed 26 patients with ARF (excluding those with prerenal azotemia and hepatorenal syndrome) between Oct 1, 1986, and April 1, 1988. The overall mortality was 42.7%, and the most common causes of death were pneumonia, septicemia, heart failure, and coronary artery disease. Death occurred primarily in those patients who had cardiac, respiratory, and hepatic