Acute Kidney Injury in the Elderly

Abdel-Kader, Khaled; Palevsky, Paul M.

doi:10.1016/j.cger.2009.04.001

Cited by 130 publications

(115 citation statements)

References 174 publications

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“…Age‐associated AKI was reported to occur more frequently in the elderly due to structural changes such as vascular sclerosis, increased percentages of sclerosing glomeruli, and other degenerative changes that occur with increasing age,18, 19 and our finding is in agreement with other publications from Fang et al,20, 21 who noted that the incidence of CSA‐AKI in the older patients was higher than that in younger patients. In our cohort we conducted a subgroup analysis according to the categorized age and found significant differences in CSA‐AKI incidence between groups (Figure 3).…”

Section: Discussionsupporting

confidence: 93%

Dynamic Predictive Scores for Cardiac Surgery–Associated Acute Kidney Injury

Jiang

Teng

et al. 2016

JAHA

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BackgroundCardiac surgery–associated acute kidney injury (CSA‐AKI) is a common complication with a poor prognosis. In order to identify modifiable perioperative risk factors for AKI, which existing risk scores are insufficient to predict, a dynamic clinical risk score to allow clinicians to estimate the risk of CSA‐AKI from preoperative to early postoperative periods is needed.Methods and ResultsA total of 7233 cardiac surgery patients in our institution from January 2010 to April 2013 were enrolled prospectively and distributed into 2 cohorts. Among the derivation cohort, logistic regression was used to analyze CSA‐AKI risk factors preoperatively, on the day of ICU admittance and 24 hours after ICU admittance. Sex, age, valve surgery combined with coronary artery bypass grafting, preoperative NYHA score >2, previous cardiac surgery, preoperative kidney (without renal replacement therapy) disease, intraoperative cardiopulmonary bypass application, intraoperative erythrocyte transfusions, and postoperative low cardiac output syndrome were identified to be associated with CSA‐AKI. Among the other 1152 patients who served as a validation cohort, the point scoring of risk factor combinations led to area under receiver operator characteristics curves (AUROC) values for CSA‐AKI prediction of 0.74 (preoperative), 0.75 (on the day of ICU admission), and 0.82 (postoperative), and Hosmer–Lemeshow goodness‐of‐fit tests revealed a good agreement of expected and observed CSA‐AKI rates.ConclusionsThe first dynamic predictive score system, with Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition, was developed and predictive efficiency for CSA‐AKI was validated in cardiac surgery patients.

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Section: Discussionsupporting

confidence: 93%

Dynamic Predictive Scores for Cardiac Surgery–Associated Acute Kidney Injury

Jiang

Teng

et al. 2016

JAHA

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“…[5] The difference can be explained by the difference in populations studied and high risk factors such as increased age, cardiovascular diseases, or by the nonuniform criteria used for defining AKI in different studies. [5][6][7] We found that a significantly increased length of hospital stay and a high rate of mortality were consistent with those reported by Chertow et al [2] The causes of death in our study were circulatory collapse and malignant arrhythmia, the mechanisms of which include fluid overload, acid-base imbalance, electrolyte imbalance, myocardial depressant factors, and activation of infl ammation. [8] The incidence of AKI has been found to be increased, especially in the elderly.…”

Section: Discussionsupporting

confidence: 81%

“…The reported incidence of AKI was 3.5-10 times higher in patients aged ≥65 years than in those aged <65 years. [6] Our data demonstrated an increased number of AKI patients in the elderly (OR=0.253). The increased incidence of AKI in the elderly is thought to be multifactorial, and it is attributable in part to anatomic and physiologic changes in the aging kidney, to an increased burden of comorbidities (hypertension, diabetes mellitus) affecting kidney function, to more frequent exposure to medications and interventions that alter renal hemodynamics or are nephrotoxic, and to alterations in drug metabolism and clearance associated with aging.…”

Section: Discussionmentioning

confidence: 73%

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

Zhang

et al. 2012

World Journal of Emergency Medicine

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BACKGROUND: Acute kidney injury following percutaneous coronary intervention (PCI) is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury (AKI) in patients after intracoronary stent implantation are still unknown. METHODS:A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included: 1) pre-operative ones: age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate (eGFR), hyperuricemia, proteinuria, emergency operation, hydration, medications (ACEI/ARBs, statins); 2) intraoperative ones: dose of contrast media, operative time, hypotension; and 3) postoperative one: hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis. RESULTS:Of the 325 patients, 51(15.7%) developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters (left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular fi ltration rate, hyperuricemia, proteinuria, hydration), emergency operation, intraoperative parameters (operative time, hypotension) and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age (OR=0.253, 95%CI=0.088-0.727), pre-operative proteinuria (OR=5.351, 95%CI=2.128-13.459), pre-operative left ventricular insufficiency (OR=8.704, 95%CI=3.170-23.898), eGFR≤60 ml/min/1.73 m 2 (OR=6.677, 95%CI=1. 167-38.193), prolonged operative time, intraoperative hypotension (OR=25.245, 95%CI=1.001-1.034) were independent risk factors of AKI.CONCLUSIONS: AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the signifi cant risk factors of AKI.

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“…Elderly patients are predisposed to AKI because of anatomic and physiologic changes of the aging kidney, an increased burden of comorbidities affecting kidney function, more frequent exposure to medications and interventions that are nephrotoxic or alter kidney hemodynamics, and alterations in drug metabolism and clearance with aging (8). A recent meta-analysis revealed that 31% of older patients failed to recover renal function after an episode of AKI compared with 26% of younger patients (9).…”

Section: Introductionmentioning

confidence: 99%

The Ethics of Offering Dialysis for AKI to the Older Patient

Akbar

Moss

2014

Clinical Journal of the American Society of Nephrology

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Older patients are more susceptible to AKI. In the elderly, AKI has been associated with increased morbidity and mortality, and it is a significant risk factor for CKD and dialysis-dependent ESRD. There are now accumulating data that the start of dialysis for some older patients is associated with poor outcomes, such as high treatment intensity, suffering, and limited life prolongation, which occur at the expense of dignity and quality of life. The biomedicalization of aging is a relatively recent field of ethical inquiry with two directly relevant features to decisions about starting dialysis for older patients with AKI: (1) the routinization of geriatric clinical interventions, such as dialysis, which results in the overshadowing of patient choice, and (2) the transformation of the technological imperative into the moral imperative. A major consequence of the biomedicalization of aging is that societal expectations about standard medical care have resulted in the relatively unquestioned provision of dialysis for AKI to older patients. This paper calls for nephrologists to re-examine the data and their attitudes to offering dialysis to older patients with AKI, especially those patients with underlying CKD and significant comorbidities. Shared decisionmaking and the reinforcement of the right of the patient to make a choice need to slow down the otherwise ineluctable routinization of starting old and very sick patients on dialysis. In the process of shared decision-making, nephrologists should not automatically recommend dialysis for older patients; in those patients who can be predicted to do poorly, recommending against dialysis upholds the Hippocratic maxim to be of benefit and do no harm. This paper challenges the automatic transformation of the technological imperative into the moral imperative for older patients with AKI and points to the need for a re-evaluation of dialysis ethics in this population.

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Acute Kidney Injury in the Elderly

Cited by 130 publications

References 174 publications

Dynamic Predictive Scores for Cardiac Surgery–Associated Acute Kidney Injury

Dynamic Predictive Scores for Cardiac Surgery–Associated Acute Kidney Injury

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

The Ethics of Offering Dialysis for AKI to the Older Patient

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