Short- and Long-Term Mortality Rates of Elderly Acute Kidney Injury Patients Who Underwent Continuous Renal Replacement Therapy

Rhee, Harin; Jang, Keum Sook; Park, Jong Man; Kang, Jin Suk; Hwang, Na Kyoung; Kim, Il Young; Song, Sang Heon; Seong, Eun Young; Lee, Jun Young; Lee, Soo Bong; Kwak, Ihm Soo

doi:10.1371/journal.pone.0167067

Cited by 24 publications

(35 citation statements)

References 32 publications

(34 reference statements)

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“…In our study, the comparative outcome in patients with conservative and RRT treatment did not show significant differences in survival (log rank p = 0.633) during the follow-up period which is by reports of Van Berendoncks et al . [ 22 - 24 ] that also showed no differences in long-term survival according to different treatment options. But our study results also deviate from the data of the other study which referred poor prognosis and increased mortality (after correction for disease severity) among elderly patients who developed dialysis requiring AKI [ 21 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Treatment on Short-Term Outcomes in Elderly Patients with Acute Kidney Injury

Petronijevic¹,

Selim²,

Petkovska³

et al. 2017

Open Access Maced J Med Sci

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BACKGROUND:Elderly population (≥ 65) are more prone to develop acute kidney injury (AKI) compared to younger, also elderly with AKI have an increased requirement for dialysis treatment and an elevated risk of short-term and long-term mortality.AIM:The objectives of this study were to examine the effect of treatment of short-term outcomes and mortality in elderly patients with AKI.MATERIAL AND METHODS:Seventy elderly AKI patients, that filled one of the criteria of AKI definition and had hospitalization over 24 hours, were enrolled in the study.RESULTS:The median age of patients was 74.28 ± 6.64, with mean CCI (Charlson Comorbidity Index) score of 6.94 ± 1.94. The majority of patients (70%) were classified at stage 3 of AKIN, 20% of patients were classified at stage 2 and 10% at stage 1. In the groups of patients with death outcome, the chronic cardiomyopathy was more frequently present (p = 0.034). Regarding treatment, 58.6% of the AKI patients underwent hemodialysis while 41.4% received conservative treatment. Mortality rate was 52.8%, out of which 28.6% was in-hospital mortality, while in 24.3% of patients death occurred in the follow-up period of 90 days.CONCLUSION:In our study, short- term survival is not related to different treatment options. Applied treatment in elderly patients with AKI should be assessed by measuring the long term outcome.

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Section: Discussionmentioning

confidence: 99%

The Effect of Treatment on Short-Term Outcomes in Elderly Patients with Acute Kidney Injury

Petronijevic¹,

Selim²,

Petkovska³

et al. 2017

Open Access Maced J Med Sci

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“…Vascular access was achieved through cannulation of the right internal jugular vein or the femoral vein using an ultrasonography-guided approach. As described in our previous report [ 12 , 13 ], the CRRT machine was operated using a continuous veno-venous hemodiafiltration (CVVHDF) mode via Prismaflex with an AN 69 ST membrane. Heparin was used as an anticoagulant in most cases, and nafamostat mesylate was used in patients with a propensity toward increased bleeding.…”

Section: Methodsmentioning

confidence: 99%

The role of the specialized team in the operation of continuous renal replacement therapy: a single-center experience

et al. 2017

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BackgroundThe requirement of continuous renal replacement therapy (CRRT) is increasing with the growing incidence of acute kidney injury (AKI). The decision to initiate CRRT is not difficult if an adequate medical history is obtained. However, the handling and maintenance of CRRT constitute a labor-intensive intervention that requires specialized skills. For these reasons, our center organized a specialized CRRT team in March 2013. The aim of this study is to report on the role of a specialized CRRT team and to evaluate the team’s outcome.MethodsThis retrospective single-center study evaluated AKI patients who underwent CRRT in the intensive care unit (ICU) from March 2011 to February 2015. Patients were divided into two groups based on whether they received specialized CRRT team intervention. We collected information on demographic characteristics, laboratory parameters, SOFA score, CRRT initiation time, actual delivered dose and CRRT down-time. In-hospital mortality was defined by medical chart review. Binary logistic regression analysis was used to define factors associated with in-hospital mortality.ResultsA total of 1104 patients were included in this study. The mean patient age was 63.85 ± 14.39 years old, and 62.8% of the patients were male. After the specialized CRRT team intervention, there was a significant reduction in CRRT initiation time (5.30 ± 13.86 vs. 3.60 ± 11.59 days, p = 0.027) and CRRT down-time (1.78 ± 2.23 vs. 1.38 ± 2.08 h/day, p = 0.002). The rate of in-hospital mortality decreased after the specialized CRRT team intervention (57.5 vs. 49.2%, p = 0.007). When the multivariable analysis was adjusted, delayed CRRT initiation (HR 1.054(1.036–1.072), p < 0.001) was a significant factor in predicting in-hospital mortality, along with an increased SOFA score, lower serum albumin and prolonged prothrombin time.ConclusionsOur study shows that specialized CRRT team intervention reduced CRRT initiation time, down-time and in-hospital mortality. This study could serve as a logical basis for implementing specialized CRRT teams hospital-wide.Electronic supplementary materialThe online version of this article (10.1186/s12882-017-0746-8) contains supplementary material, which is available to authorized users.

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“…In a Japanese study by Iwagami et al [16], the inhouse mortality rate of elderly patients on CRRT was 50.6%, and was largely associated with the severity of illness at baseline, as evidenced by use of mechanical ventilation, vasoactive support, and blood transfusion. A single-center, retrospective cohort study of 562 patients aged ≥ 54 years who underwent CRRT reported a short-term mortality rate (death during hospital stay or within 1 week of discharge) of 57.3% [40]. In addition to…”

Section: Mortality Dialysis Dependence and Risk For Chronic Kidney mentioning

confidence: 99%

“…Because elderly are more susceptible to intra-dialytic hemodynamic, neurologic, and bleeding complications, therapeutic decisions tend to be more conservative. Elderly patients receive less-intensive treatment; more-invasive modalities are typically withheld [40,50,51].…”

Section: Withholding Crrtmentioning

confidence: 99%

Continuous renal replacement therapy in elderly with acute kidney injury

Medina-Liabres

Kim

2020

Korean J Intern Med

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The objective of this article is to raise awareness among physicians of the increasing incidence of acute kidney injury in the elderly population and the utility of continuous renal replacement therapy (CRRT) in its management. While CRRT is frequently applied in younger patients, its use in elderly patients is less frequent, for various reasons, including resistance to such an aggressive intervention from the family and the healthcare team. However, predictors of prognosis have been identified and some studies have concluded that advanced age is not associated with poor outcomes. Decisions regarding management are more complex when dealing with the elderly but like very other patient, the approach should be patient-centered.

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Short- and Long-Term Mortality Rates of Elderly Acute Kidney Injury Patients Who Underwent Continuous Renal Replacement Therapy

Cited by 24 publications

References 32 publications

The Effect of Treatment on Short-Term Outcomes in Elderly Patients with Acute Kidney Injury

The Effect of Treatment on Short-Term Outcomes in Elderly Patients with Acute Kidney Injury

The role of the specialized team in the operation of continuous renal replacement therapy: a single-center experience

Continuous renal replacement therapy in elderly with acute kidney injury

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