Outcomes of renal function in elderly patients with acute kidney injury

Clinical Interventions in Aging, Jan 2017

Outcomes of renal function in elderly patients with acute kidney injury Qinglin Li,1 Meng Zhao,2 Jing Du,1 Xiaodan Wang1,3 1Department of Geriatric Nephrology, 2Department of Clinical Data Repository, 3Department of Health Care, Chinese PLA General Hospital, Beijing, People’s Republic of China 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. Keywords: acute kidney injury, elderly, prognosis, renal function, risk factors

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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)


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Qinglin Li, Meng Zhao, Jing Du, Xiaodan Wang. Outcomes of renal function in elderly patients with acute kidney injury, Clinical Interventions in Aging, 2017, pp. 153-160, DOI: 10.2147/CIA.S121823