Earlier nephrology consultation may not be associated with improved short-term survival of acute kidney injury in very elderly men

Clinical Interventions in Aging, Dec 2016

Earlier nephrology consultation may not be associated with improved short-term survival of acute kidney injury in very elderly men Qinglin Li,1 Meng Zhao,2 Jing Du,1 Xiaodan Wang1 1Department of Geriatric Nephrology, 2Department of Clinical Data Repository, Chinese People’s Liberation Army General Hospital, Beijing, China Objectives: A delayed nephrology consultation (NC) may be associated with a poor prognosis in acute kidney injury (AKI) patients. The aims of this study were to compare the clinical and laboratory characteristics of elderly AKI patients evaluated and not evaluated by nephrologists and to generate a hypothesis regarding the relationship between the timing of the NC and 90-day outcomes. Methods: From 2007 to 2015, this study explored associations among the presence and timing of NC with the non-intensive care unit stay and 90-day mortality in elderly AKI patients at the Geriatric Department of the Chinese People’s Liberation Army General Hospital. Early NC and delayed NC were defined as NCs performed before and 2 days after the day of AKI diagnosis, respectively. Multivariable logistic regression was used to adjust for confounding and selection bias. Results: In total, 623 patients were included for the final analysis, of whom 162 (26%) were evaluated by nephrologists. The 90-day mortality rate was 33.2%, and dialysis was required in 1.4% of patients (9/623). Multivariable analysis showed that a higher prevalence of preexisting chronic obstructive pulmonary disease, AKI diagnosis time, peak serum creatinine level, blood urea nitrogen level, AKI stage, and mortality was associated with the NC. The NC was delayed (>48 h) in 59 patients (36.4%) (median time to consultation, 4 days). The median AKI diagnosis time, presence of oliguria, uric acid level, and a more severe AKI stage were associated with delayed consultation. Moreover, delayed consultation presented a similar 90-day mortality rate to that of an early NC (50.8% vs 44.7%, respectively, P=0.448). Conclusion: In very elderly AKI patients, those evaluated by nephrologists have more severe AKI and a higher mortality rate than those not evaluated by nephrologists. An earlier NC may not be associated with improved 90-day survival. Keywords: acute kidney injury, very elderly, mortality, nephrology consultation, risk factors, outcomes

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Earlier nephrology consultation may not be associated with improved short-term survival of acute kidney injury in very elderly men

Clinical Interventions in Aging earlier nephrology consultation may not be associated with improved short-term survival of acute kidney injury in very elderly men Qinglin li 1 Meng Zhao 0 Jing Du 1 Xiaodan Wang 1 0 Department of Clinical Data repository , Chinese People's liberation Army general hospital, Beijing , China 1 Department of geriatric n ephrology PowerdbyTCPDF(ww.tcpdf.org) Objectives: A delayed nephrology consultation (NC) may be associated with a poor prognosis in acute kidney injury (AKI) patients. The aims of this study were to compare the clinical and laboratory characteristics of elderly AKI patients evaluated and not evaluated by nephrologists and to generate a hypothesis regarding the relationship between the timing of the NC and 90-day outcomes. Methods: From 2007 to 2015, this study explored associations among the presence and timing of NC with the non-intensive care unit stay and 90-day mortality in elderly AKI patients at the Geriatric Department of the Chinese People's Liberation Army General Hospital. Early NC and delayed NC were defined as NCs performed before and 2 days after the day of AKI diagnosis, respectively. Multivariable logistic regression was used to adjust for confounding and selection bias. Results: In total, 623 patients were included for the final analysis, of whom 162 (26%) were evaluated by nephrologists. The 90-day mortality rate was 33.2%, and dialysis was required in 1.4% of patients (9/623). Multivariable analysis showed that a higher prevalence of preexisting chronic obstructive pulmonary disease, AKI diagnosis time, peak serum creatinine level, blood urea nitrogen level, AKI stage, and mortality was associated with the NC. The NC was delayed (.48 h) in 59 patients (36.4%) (median time to consultation, 4 days). The median AKI diagnosis time, presence of oliguria, uric acid level, and a more severe AKI stage were associated with delayed consultation. Moreover, delayed consultation presented a similar 90-day mortality rate to that of an early NC (50.8% vs 44.7%, respectively, P=0.448). Conclusion: In very elderly AKI patients, those evaluated by nephrologists have more severe AKI and a higher mortality rate than those not evaluated by nephrologists. An earlier NC may not be associated with improved 90-day survival. - 8 1 0 2 l u J 2 1 n o 1 2 1 . 9 5 . 2 3 . 3 1 2 y b / m o c . s s e phenomenon is that the SCr level alone is a relatively late and imprecise biomarker of kidney dysfunction, which may also lead to a delayed diagnosis, especially in the elderly population.10,11 Clinical studies have shown that a timely nephrology consultation (NC) could potentially have many benefits such as allowing earlier identification and modification of AKI patients’ outcomes. For example, Mehta et al concluded that a delayed NC was associated with increased mortality among dialyzed and nondialyzed patients in the intensive care unit (ICU).12 Recent studies have also indicated that an early NC may improve hospital-acquired AKI prognosis,12–16 although few studies have examined the effect of an early NC on outcomes in very elderly patients ($75 years) or diagnosing AKI using KDIGO criteria. The aims of this study were to compare the clinical and laboratory characteristics of elderly AKI patients evaluated and not evaluated by nephrologists and to generate a .rvdoepww ll.syeuon ahnydpo9t0h-edsaisyoofutthceomreelast.ionship between the timing of the NC tt:/sphw rsopea Study population and methods / n from roF This was a retrospective cohort study. All elderly patients ed ($75 years) who were admitted to the Geriatric Department lado of the Chinese People’s Liberation Army (PLA) General onw Hospital between January 2007 and December 2015 were gnd evaluated for AKI during their hospital stay. The study igA design was approved by the Clinical Ethics Committee of the isn Chinese PLA General Hospital, and each participant provided itonn written informed consent. All AKI patients were followed ltIrveen up fCorli9n0icdalaydsaataftewreAreKnIodtieadg,n oinsicsluodriunngtitlhdeeadtehm.ographic liicanC (phroisftiolery(aogfeh,ygpenerdteern,sainodn,bcoodryonmaarsysdinisdeeaxs)ea,nchdrcoonmicoorbbisdtrituicestive pulmonary disease [COPD], and diabetes mellitus), time of AKI diagnosis, etiology of AKI (induced by infection, hypovolemia, cardiovascular events, nephrotoxic drugs, surgery, or uncertain causes), need for dialysis, need for mechanical ventilation (MV), urine output, and mean aortic pressure. Other laboratory data evaluated included baseline levels of SCr, SCr at AKI diagnosis, peak SCr, blood urea nitrogen (BUN), uric acid, serum prealbumin, albumin, kalemia, serum calcium, serum magnesium, serum phosphate, and hemoglobin. AKI was diagnosed exclusively based on SCr levels, that is, an SCr increase $0.3 mg/dL ($26.5 µmol/L) within 48 h, or an increase to $1.5-fold above the baseline submit your manuscript | www.dovepress.com Dovepress value within the prior 7 days.1 The KDIG (...truncated)


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Qinglin Li, Meng Zhao, Jing Du, Xiaodan Wang. Earlier nephrology consultation may not be associated with improved short-term survival of acute kidney injury in very elderly men, Clinical Interventions in Aging, 2016, pp. 11-18, DOI: 10.2147/CIA.S120819