Outcomes of renal function in elderly patients with acute kidney injury
Clinical Interventions in Aging
Outcomes of renal function in elderly patients with acute kidney injury
Qinglin li 2
Meng Zhao 1
Jing Du 2
Xiaodan Wang 0 2
0 Department of h ealth Care, Chinese PlA general hospital , Beijing, People's republic of China
1 Department of Clinical Data repository
2 Department of geriatric n ephrology
8 1 0 2 - l u J - 2 1 n o 7 0 2 . 6 4 . 9 5 . 7 3 y b / m o c . s s e r PowerdbyTCPDF(ww.tcpdf.org) Objectives: The aim of this study was to explore the prognostic impact of clinical factors on the short-term outcomes of renal function (RF) in very elderly patients with acute kidney injury (AKI). Patients and methods: We carried out a retrospective cohort study of only very elderly patients who developed AKI at the geriatric department of a tertiary medical center during the period 2007-2015. All patients with AKI were followed up for 90 days after AKI diagnosis or until death. Survivors were divided into recovery and nonrecovery groups according to their RF 90 days post-AKI. RF recovery was defined as an estimated glomerular filtration rate (eGFR) of $60 mL/min/1.73 m2. Results: In total, 668 patients (39.0%) developed AKI, and 652 patients were included in the final analysis. The median age of this population was 87 years, with 95.6% being male. The 90-day mortality rate was 33.6%. Of the 433 survivors, 316 (73.0%) recovered to their baseline eGFR. Body mass index (BMI), baseline eGFR, low mean aortic pressure (MAP), low prealbumin level, hypoalbuminemia, oliguria, blood urea nitrogen (BUN) level, and more severe AKI stage were independent risk factors associated with nonrenal recovery or death. AKI etiology, evaluated by peak serum creatinine (SCr) level and the requirement for dialysis, was not associated with nonrenal recovery. Conclusion: Risk factors for the poor outcomes of RF in very elderly patients with AKI were BMI, baseline eGFR, low MAP, low prealbumin level, hypoalbuminemia, oliguria, BUN level, and more severe AKI stage. Identifying risk factors may help to improve patient outcomes.
-
The rate of RF recovery post-AKI varies in the literature,
possibly due to the lack of a consistent definition of what
constitutes renal recovery.8,9 Previous studies on recovery
from AKI-induced RF have focused on clinical outcomes
often assessed at the time of hospital discharge,3,10–13 and
they defined RF recovery as the weaning of the patient from
dialysis or a decrease in serum creatinine (SCr) levels to
18 below a defined threshold.3,10,12–15 The prevalence of post-AKI
l-02 renal recovery in these available studies has varied widely
-J2u between 33% and 86%.3,11,12,14,15 However, various chronic
no1 conditions, refractory pulmonary infection, and the
neces027 sity of prolonged mechanical ventilation (MV) can often
..64 extend the hospital stays of the elderly. Thus, evaluation of
.579 RF recovery and mortality only from the time of hospital
y3b discharge is inappropriate, particularly for patients older
./cssom trhepanor7te5d yReFarosu.tTcohmereeaacrceorsdtiilnlgotnolAy KaIfseewvesrtiutyd,i1e2s,15tahnadt nhoavnee
re of these studies used the 2012 Kidney Disease Improving
.vdoepww l.syeonu and assess recovery.1
Global Outcomes (KDIGO) criteria to both diagnose AKI
//:sw laon The objectives of this study were to, 1) compare the rates
tthp rsep of complete recovery or nonrecovery from different stages
from roF of AKI, as defined by the KDIGO criteria; 2) examine the
ed effect of AKI on short-term RF outcomes and mortality; and
loda 3) identify the rate of recovery from RF at 90 days post-AKI
onw and its risk factors.
d
g
n
i
g
A
n
i
s
n
o
it
n
e
v
tr
e
n
lI
a
c
iil
n
C
Patients and methods
This was a retrospective cohort study performed in the
Geriatric Department of the Chinese PLA General Hospital.
We collected data of very elderly patients ($75 years of age)
who were treated from January 1, 2007, to December 31,
2015. All patients who developed AKI were enrolled. The
study design was approved by the Clinical Ethics Committee
of the Chinese PLA General Hospital, and each patient
provided written informed consent. Patients were divided into
groups of survivors or nonsurvivors based on their survival
status at 90 days. Survivors were further divided into recovery
and nonrecovery groups based on their RF at 90 days
postAKI. To assess the risk factors of prognosis, we separated
the patients into 2 groups based on whether they progressed
to nonrecovery or died.
AKI was diagnosed with reference (exclusively) to
the patient’s SCr level, specifically, by an SCr increase
of $0.3 mg/dL ($26.5 µmol/L) within 48 h, or a $1.5-fold
increase relative to the baseline value, known or presumed to
have developed within the prior 7 days.1 The severity of AKI
was defined by the KDIGO staging criteria. Estimated GFRs
submit your manuscript | www.dovepress.com
Dovepress
(eGFRs) were calculated by the Chronic Kidney Disease
Epidemiology Collaboration (CKD-EPI).16
We noted the age and gender of p (...truncated)