Factors Affecting Inpatient Mortality in Elderly People with Acute Kidney Injury

Abstract

Background Acute Kidney Injury (AKI) is common in elderly people (EP). There is paucity of data on predictor of mortality in EP with AKI. Objective This study was done to know more about factors associated with inpatient mortality in EP with AKI. Methods We retrospectively reviewed medical records of patients aged 65 years or above hospitalized with a diagnosis of AKI at Aga Khan University Hospital, Karachi, between January 2005 and December 2010. Binary logistic regression models were constructed to identify factors associated with mortality in EP with AKI. Results 431 patients had AKI, with 341 (79.1%) having stage I AKI, 56 (13%) having stage II AKI, and 34 (7.9%) having stage III AKI. Out of 431 patients, 142 (32.9%) died. Mortality increased with increasing severity of AKI. Mortality was 50% (17/34) in AKI stage III, 44.6% (25/56) in AKI stage II, and 29.3% (100/341) in AKI stage I. Factors associated with increased inpatients mortality were presence of stage III AKI (OR: 3.20, P = 0.04, 95% CI: 1.05–9.72), presence of oliguria (OR: 3.42, P = 0.006, 95% CI: 1.42–8.22), and need for vasopressors (OR: 6.90, P < 0.001, 95% CI: 2.42–19.65). Median bicarbonate 18 versus 17 between those who survived and those who died was associated with less mortality (OR: 0.94, P = 0.02, 95% CI: 0.89–0.99). History of hypertension (OR: 0.49, P = 0.03, 95% CI: 0.25–0.95) and high admission creatinine (OR: 0.68, P = 0.01, 95% CI: 0.50–0.91) were also associated with less mortality. Conclusion Mortality in EP increases with increasing severity of AKI. Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality. Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality. Increasing age and need for dialysis did not increase mortality in elderly population.

Effect of renal replacement therapy modalities on renal recovery and mortality for acute kidney injury: A PRISMA‐compliant systematic review and meta‐analysis

“…According to previous studies, worse baseline renal function and more frequent intradialytic hypotension were associated with lower likelihood of renal recovery 31,32 . Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality 33 . Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality 33 .…”

“…Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality 33 . However, mortalities are not influenced by ages 33 . In addition, hypotension during dialysis is a serious problem and it is an independent risk factor of mortality in dialyzed patients 34,35 .…”

“…31,32 Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality. 33 Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality. 33 However, mortalities are not influenced by ages.…”

“…33 However, mortalities are not influenced by ages. 33 In addition, hypotension during dialysis is a serious problem and it is an independent risk factor of mortality in dialyzed patients. 34,35 Abe et al reported no significant differences in baseline serum creatinine and numbers of patients experienced hypotension which required discontinuation of the treatment during the procession of CRRT and SLED.…”

Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

“…On the contrary, some studies have reported that age was not an independent risk factor for mortality in AKI patients >60 years of age [8,27]. e mortality rate of elderly patients with AKI has been reported to be 18%-61% [8,[28][29][30]; this wide range could be due to the heterogeneity of the study populations, availability of a critical care unit, standard of care administered, or research methodology used. e present study reported similar in-hospital mortality rates between the elderly and nonelderly patients with AKI.…”