Prognosis of in hospital nonagenarians with acute kidney injury

doi:10.23938/assn.0955

Cited by 3 publications

(6 citation statements)

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“…In-hospital mortality in nonagenarians with AKI according to published articles ranges from 23% to 70%, depending on mean age, patient severity, comorbidity profile and criteria for defining AKI 3 , 4 , 6 . In our study, we observed a mortality rate of 56.7%, similar to other published data, which may be justified by the prevalence of comorbidities and severity of the study group.…”

Section: Discussionmentioning

confidence: 99%

“…In the surviving group, there was a high prevalence of CKD, KDIGO 1 and dehydration/hypovolemia. Data suggest that CKD patients who develop AKI have a lower risk of death 17 , and are not associated with worse outcomes 3 . In our study, although CKD was more prevalent in the survivor group (50.8%, p = 0.019), it was not identified as a lower risk factor for mortality in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Among the elderly, the population aged over 80 is the fastest-growing demographic 2 . Nevertheless, there are still few studies on patients aged over 90 years, and the available data are inconclusive regarding the profile of comorbidities and prognosis in this population 3 .…”

Section: Introductionmentioning

confidence: 99%

“…With aging, different physiological and functional changes occur in the kidneys, such as a reduction in glomerular filtration rate, loss of cortical volume and nephrosclerosis 4 . Advanced age and polypharmacy may be considered risk factors for kidney diseases, and in hospitalized patients, Acute Kidney Injury (AKI) is a prominent condition in the elderly, altering the individual’s prognosis 3 , 4 , 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Among the elderly, nonagenarians seem to have unique characteristics, comorbidities and clinical outcomes 2 , 3 , 5 , 6 . The incidence of AKI is high in patients in this age group hospitalized for any underlying pathology 3 . However, published studies on AKI in nonagenarians are still insufficient.…”

Section: Introductionmentioning

confidence: 99%

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Acute kidney injury in nonagenarians: clinical characteristics and mortality

Dias,

Duarte,

Barbosa

et al. 2024

Braz. J. Nephrol.

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Introduction: Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. Methods: Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. Results: A total of 150 patients were included, with a median age of 93.0 years (91.2–95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04–0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17–8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03–49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98–16.85, p = 0.001) were associated with mortality. Conclusion: AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute kidney injury in nonagenarians: clinical characteristics and mortality

Dias,

Duarte,

Barbosa

et al. 2024

Braz. J. Nephrol.

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Infectious consequences of the AKI-to-CKD transition

Horrillo

Villanueva

Cárdenas

et al. 2022

Clinical Kidney Journal

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Background Acute kidney injury (AKI) is associated with short- and long-term complications but the consequences of the AKI-to-CKD transition are still poorly understood. We aimed to evaluate the association between the AKI-to-CKD transition and the long-term risk of infection. Methods This retrospective study included patients admitted in a tertiary hospital with community-acquired AKI in 2013 and 2014 that had estimated glomerular filtration rate (eGFR) assessed at 3 months (±2 weeks) after serum creatinine peaked in the AKI episode. Key exclusion criteria were baseline CKD or confounding factors (active neoplasia, primary immunodeficiency, HIV, immunosuppressive drugs). The association between the AKI-to-CKD transition (defined as having eGFR < 60 ml/min/1.73 m2 at 3 months) and long-term infections (defined using clinical features, blood/urine analysis, cultures and image) was assessed during a follow-up of 9 (2–56) months. Results Among the 1731 patients admitted with AKI, 367 (21%) were included in the present analysis (64% male, 71 ± 15 years). Three months after AKI, 159 (43%) developed AKI-to-CKD transition. Baseline and post-AKI eGFR were independent predictors of AKI-to-CKD transition (HR 0.97, p = 0.044 and HR 0.96, p < 0.001, respectively). During follow-up, 153 (42%) patients developed an infection. Factors associated to infection were older age, cognitive impairment, lower post-AKI eGFR, eGFR loss from baseline to 3 months and AKI-to-CKD transition. Adjusted Cox regression showed that baseline eGFR, 3-month eGFR, eGFR loss and AKI-to-CKD transition were independent predictors of the long-term risk of infection. Conclusions The AKI-to-CKD transition independently predicts the long-term risk of infection following an episode of AKI.

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Injúria renal aguda em nonagenários: características clínicas e mortalidade

Dias,

Duarte,

Barbosa

et al. 2024

Braz. J. Nephrol.

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Resumo Introdução: Nonagenários constituem um percentual de pacientes internados em ascensão, sendo a injúria renal aguda (IRA) frequente nesses pacientes. Sendo assim, é importante analisar as características clínicas dessa população e seu impacto na mortalidade. Métodos: Estudo retrospectivo de pacientes nonagenários com IRA entre 2013 e 2022 em um hospital terciário. Apenas o último internamento foi considerado e pacientes com dados incompletos foram excluídos. Uma análise por regressão logística foi realizada para definir fatores de risco para mortalidade. Um valor de p < 0,05 foi considerado significativo. Resultados: Foram incluídos 150 pacientes com mediana de idade 93,0 anos (91,2–95,0) e sexo masculino em 42,7%. Sepse foi a causa mais comum de IRA (53,3%), seguida de desidratação/hipovolemia (17,7%) e insuficiência cardíaca (17,7%). Admissão na UTI ocorreu em 39,3% dos pacientes, ventilação mecânica em 14,7%, uso de vasopressores em 22,7% e realização de terapia renal substitutiva (TRS) em 6,7%. Óbito ocorreu em 56,7% dos pacientes. Desidratação/hipovolemia como etiologia da IRA foi associado a menor risco de mortalidade (OR 0,18; IC 95% 0,04–0,77, p = 0,020). Estágio KDIGO 3 (OR 3,15; IC 95% 1,17–8,47, p = 0,023), admissão na UTI (OR 12,27; IC 95% 3,03–49,74, p < 0,001) e oligúria (OR 5,77; IC 95% 1,98–16,85, p = 0,001) foram associados à mortalidade. Conclusão: Nonagenários com IRA apresentaram alta mortalidade e IRA KDIGO 3, oligúria e admissão na UTI foram associadas ao óbito.

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Prognosis of in hospital nonagenarians with acute kidney injury

Cited by 3 publications

References 32 publications

Acute kidney injury in nonagenarians: clinical characteristics and mortality

Acute kidney injury in nonagenarians: clinical characteristics and mortality

Infectious consequences of the AKI-to-CKD transition

Injúria renal aguda em nonagenários: características clínicas e mortalidade

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