The impact of dialysis on critically ill elderly patients with acute kidney injury: an analysis by propensity score matching

Teles, Flávio; Santos, Renata Oliveira; Lima, Helder Marx Almeida de Moura; Campos, Rodrigo Peixoto; Teixeira, Eline Calumby; Alves, Ananda Camilla de Andrade; Costa, André Falcão Pedrosa; Coelho, Jorge Artur Peçanha de Miranda

doi:10.1590/2175-8239-jbn-2018-0058

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…Recently, Abudayyeh et al [ 26 ] studied the impact of RRT in 465 cancer patients admitted to the ICU; mortality at hospital discharge compared with patients who did not receive RRT adjusted by the propensity score showed no differences in the risk of mortality at hospital discharge. Similar findings were observed in patients older than 70 years who required dialysis in the ICU, with no differences in mortality at ICU discharge compared with patients who did not require RRT [ 27 ]. While Lebiedz’s study concludes that in 524 critically ill patients with mechanical ventilation requirements, pre-existing CKD has a marked impact on the occurrence of acute renal failure, 30 days and 1-year mortality [ 28 ].…”

Section: Discussionsupporting

confidence: 71%

Effect of renal support therapy on 5-year survival in patients discharged from the intensive care unit

Oliveros

Buitrago

2020

j intensive care

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Background: Between 30 and 70% of patients admitted to the intensive care unit (ICU) have acute kidney injury (AKI), and 10% of these patients will require renal replacement therapy (RRT). A significant number of studies have compared the mortality of patients who require RRT versus those who do not require it, finding an increase in mortality rates in the short and medium term; however, few studies have evaluated the long-term survival in a mixture of patients admitted to the ICU. Objective: To evaluate the impact of RRT on 5-year survival in patients with AKI admitted to the ICU Methods: Using administrative databases of insurers of the Colombian health system, a cohort of patients admitted to the ICU between 1 January 2012 and 31 December 2013 was followed until 31 December 2018. ICD-10 diagnoses, procedure codes, and prescribed medications were used to establish the frequencies of the comorbidities included in the Charlson index. Patients were followed for at least 5 years to evaluate survival and establish the adjusted risks by propensity score matching. Results: Of the 150,230 patients admitted to the ICU, 4366 (2.9%) required RRT in the ICU. Mortality rates for patients with RRT vs no RRT evaluated at ICU discharge, 1 year, and 5 years were 35%, 57.4%, and 67.9% vs 7.4%, 17.6%, and 30.1%, respectively. After propensity score matching, the hazard ratio was calculated for patients who received RRT and those who did not (HR, 2.46; 95% CI 2.37 to 2.56; p < 0.001), with a lower difference in years of survival for patients with RRT (mean effect in the treated) of − 1.86 (95% CI − 2.01 to to1.65; p < 0.001). Conclusions: The impact of acute renal failure with the consequent need for RRT in patients admitted to the ICU is reflected in a decrease of approximately one quarter in 5-year survival, regardless of the different comorbidities.

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Section: Discussionsupporting

confidence: 71%

Effect of renal support therapy on 5-year survival in patients discharged from the intensive care unit

Oliveros

Buitrago

2020

j intensive care

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“… 25 Sepsis, shock, inotropes, mechanical ventilation, length of hospital stay, and advanced age are the important independent predictors of AKI. 25 , 27 …”

Section: Discussionmentioning

confidence: 99%

A Clinical and Demographic Profile of Elderly (>65 Years) in the Medical Intensive Care Units of a Tertiary Care Center

Prabhudev¹,

Ramamoorthi²,

Acharya³

2023

Indian Journal of Critical Care Medicine

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A bstract Background The elderly population in India is expected to increase to 319 million by 2050. Managing critically ill elderly patients in intensive care units (ICUs) is a difficult task. Proper planning and development of healthcare infrastructure are of prime importance to face this challenge. Objectives To study the clinical profile and outcomes of elderly patients admitted to the medical ICUs. Materials and methods A time-bound, prospective observational study on elderly patients admitted to medical ICUs for more than 48 hours was conducted from March 2019 to September 2020. The demographic, biochemical, hematologic, and microbiological data on antibiotic susceptibility patterns on various organisms and procalcitonin (PCT) reports were collected. Acute Physiology and Chronic Health Evaluation II (APACHE II) score was calculated. Various treatment modalities, such as mechanical ventilation, inotropes, hemodialysis, antibiotics, culture report in sepsis patients, and length of ICU stay were collected. Results The age of the patients and the length of their ICU stay were not significantly associated with outcomes. Sepsis and APACHE II scores are significantly associated with outcomes. Receipt of mechanical ventilation, vasopressor support, and hemodialysis are significantly associated with mortality ( p < 0.001). Conclusion The patients’ ages were not significantly associated with outcomes. The most common cause of death among elderly patients was found to be sepsis, followed by pneumonia. In elderly ICU patients, gram-negative organisms are the most common causative agents in bloodstream infections. The APACHE II score, sepsis, receipt of mechanical ventilation, vasopressor support, and hemodialysis are significantly associated with mortality. How to cite this article Prabhudev P, Ramamoorthi K, Acharya RV. A Clinical and Demographic Profile of Elderly (>65 Years) in the Medical Intensive Care Units of a Tertiary Care Center. Indian J Crit Care Med 2023;27(3):166–175.

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“…Apart from withdrawing or withholding care, not all therapeutic interventions seem to favor the elderly’s chances of survival. Dialysis does not seem to impact the death rates of critically ill patients with acute kidney injury aged 70 + years ( Teles et al, 2019 ). Even in the context of the COVID-19 pandemic, the role of corticosteroids in the elderly remained controversial.…”

Section: Discussionmentioning

confidence: 99%

The impact of age on intensive care

Akinosoglou¹,

Schinas²,

Almyroudi³

et al. 2023

Ageing Research Reviews

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The impact of dialysis on critically ill elderly patients with acute kidney injury: an analysis by propensity score matching

Abstract: The data suggested that dialysis did not seem to impact the death rates of critically ill patients with AKI aged 70+ years.

Cited by 8 publications

References 22 publications

Effect of renal support therapy on 5-year survival in patients discharged from the intensive care unit

Effect of renal support therapy on 5-year survival in patients discharged from the intensive care unit

A Clinical and Demographic Profile of Elderly (>65 Years) in the Medical Intensive Care Units of a Tertiary Care Center

The impact of age on intensive care

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