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1
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Kumthekar GV, Purandare V, Nagarkar M, Paramshetti S. Mortality Analysis in Geriatric Patients With Acute Kidney Injury Admitted in the Intensive Care Unit: A Single-Center Cross-Sectional Study. Cureus 2024; 16:e54509. [PMID: 38516467 PMCID: PMC10955431 DOI: 10.7759/cureus.54509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Acute kidney injury (AKI) is an abrupt reduction in kidney function that causes nitrogenous waste and other waste products to be retained. Methods This cross-sectional study was conducted from February 2015 to January 2016. The study received approval from the Independent Ethics Committee, which included patients over 60 with AKI. The study duration was 12 consecutive months to ascertain the etiology, severity, and hospital outcomes of AKI. Results The common etiologies of AKI included drug-induced (25%), age-related (21.67%), cardiac (13.33%), respiratory (20%), tropical (15%), and pancreatitis (15%) cases. Another predominant etiology observed was obstructive nephropathy (55%), with the highest (37.5%) mortality rate. The distribution of patients based on KDIGO criteria showed no significant difference in mortality percentages among classes (p=0.177). Conservative management without renal replacement therapy was the most common approach to treat AKI, with a 39% mortality rate. Conclusion Among different causes of AKI in the geriatric age group, drug-induced AKI, and obstructive nephropathy were predominantly associated with hospital mortality.
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Affiliation(s)
- Girish V Kumthekar
- Nephrology, Symbiosis Medical College for Women, Symbiosis University Hospital and Research Centre, Symbiosis International University, Pune, IND
| | - Veena Purandare
- Internal Medicine, Symbiosis Medical College for Women, Symbiosis University Hospital and Research Centre, Symbiosis International University, Pune, IND
| | - Manasi Nagarkar
- Internal Medicine, Symbiosis Medical College for Women, Symbiosis University Hospital and Research Centre, Symbiosis International University, Pune, IND
| | - Shruti Paramshetti
- Internal Medicine, Bharati Vidyapeeth Medical College and Hospital, Sangli, IND
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Bani Hani A, Abu Abeeleh M, Al-Najjar S, Alzibdeh A, Mansour S, Bsisu I, Awamleh N, Farah R. Incidence, risk factors and outcomes of acute kidney injury in surgical intensive care unit octogenarians at the Jordan University Hospital. BMC Geriatr 2023; 23:266. [PMID: 37142956 PMCID: PMC10158325 DOI: 10.1186/s12877-023-03975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/15/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Acute kidney damage (AKI) is among the most severe consequences observed in surgical intensive care units (SICUs). We aim to observe the incidence, risk factors, and outcomes of acute kidney injury in SICU octogenarians. METHODS A cross-sectional retrospective study was conducted at the SICU of Jordan University Hospital (JUH), a tertiary teaching hospital in a developing country, between January 2018 and December 2019. Patients who were 80 years or older at the time of data collection were included. The definition of AKI was based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Demographic, clinical, and laboratory data were reviewed. RESULTS A total number of 168 patients were included. The mean age was 84.0 ± 3.8 years, and 54.8% of the participants were women. Of those, 115 (68.5%) had surgery before or during ICU stay, and 28.7% of the patients' surgeries were an emergency surgery. Also, 47.8% of surgeries were considered by anesthesia to be high-risk surgeries. A total of 55 patients (32.7%) developed AKI during their SICU stay. The factors that were significantly associated with AKI in the ICU patients included use of beta blocker [AOR: 3.7; 95% CI: 1.2-11.8; p = 0.025], and inotropes [AOR:4.0; 95% CI: 1.2-13.3; p = 0.03]. The factors that were significantly associated with mortality in the ICU included using mechanical ventilation [AOR:18.7; 95% CI: 2.4-141.9; p = 0.005] and inotropes use [AOR: 12.3; 95% CI: 1.2-120.7; p = 0.031]. CONCLUSIONS The incidence of AKI during SICU stay in this study was 32.7% and it was significantly associated with the use of beta blockers, mechanical ventilation, and inotropes. The mortality rate among octogenarians who developed AKI during SICU stay was 36.4%. Further studies are needed globally to assess the incidence of AKI in octogenarian surgical patients and identify risk factors to provide preventative measurements and strategies.
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Affiliation(s)
- Amjad Bani Hani
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mahmoud Abu Abeeleh
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Sondos Al-Najjar
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | | - Shahd Mansour
- School of Medicine, The University of Jordan, Amman, 11942, Jordan.
| | - Isam Bsisu
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Nour Awamleh
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Randa Farah
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan
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Guo L, Chen D, Cheng B, Gong Y, Wang B. Prognostic Value of the Red Blood Cell Distribution Width-to-Albumin Ratio in Critically Ill Older Patients with Acute Kidney Injury: A Retrospective Database Study. Emerg Med Int 2023; 2023:3591243. [PMID: 37051465 PMCID: PMC10085652 DOI: 10.1155/2023/3591243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
Background. There is no evidence suggesting that red blood cell distribution width-to-albumin ratio (RA) predicts outcomes in severely ill older individuals with acute kidney injury (AKI). We hypothesized that RA is associated with all-cause mortality in critically ill older patients with AKI. Methods. We recorded demographics, laboratory tests, comorbidities, vital signs, and other clinical information from the MIMIC-III V1.4 dataset. The primary endpoint was 90-day all-cause mortality, and the secondary endpoints were 30-day mortality, one-year mortality, renal replacement treatment (RRT), duration of stay in the intensive care unit (ICU), sepsis, and septic shock. We generated Cox proportional hazards and logistic regression models to determine RA’s prognostic values and subgroup analyses to determine the subgroups’ mortality. We conducted a Pearson correlation analysis on RA and C-reactive protein (CRP) in the cohort of patients from the Second Affiliated Hospital of Wenzhou Medical University. Results. A total of 6,361 patients were extracted from MIMIC-III based on the inclusion and exclusion criteria. RA levels directly and linearly correlated with 90-day all-cause mortality. After controlling for ethnicity, gender, age, and other confounding variables in multivariate analysis, higher RA was significantly associated with an increased risk of 30-day, 90-day, and one-year all-cause mortality as opposed to the reduced levels of RA (tertile 3 vs. tertile 1: hazard ratios (HRs), 95% confidence intervals (CIs): 1.70, 1.43–2.01; 1.90, 1.64–2.19; and 1.95, 1.72–2.20, respectively). These results suggested that elevated levels of RA were linked to an elevated risk of 30-day, 90-day, and one-year all-cause death. There was a similar trend between RA and the use of RRT, length of stay in ICUs, sepsis, and septic shock. The subgroup analysis did not reveal any considerable interplay among strata. When areas under the curve were compared, RA was a weaker predictor than the SAPS II score but a stronger predictor than red blood cell distribution width (RDW) or albumin alone (
); RA combined with SAPS II has better predictive power than SAPS II alone (
). The Second Affiliated Hospital of Wenzhou Medical University cohort showed that CRP positively correlated with RA, with a coefficient of 0.2607 (
). Conclusions. RA was an independent prognostic predictor in critically ill older patients with AKI, and greater RA was linked to a higher probability of death. The risk of AKI is complicated when RRT occurs; sepsis and septic shock increase with RA levels.
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Affiliation(s)
- Lei Guo
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Dezhun Chen
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Bihuan Cheng
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Yuqiang Gong
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Benji Wang
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
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Turgut F, Awad AS, Abdel-Rahman EM. Acute Kidney Injury: Medical Causes and Pathogenesis. J Clin Med 2023; 12:jcm12010375. [PMID: 36615175 PMCID: PMC9821234 DOI: 10.3390/jcm12010375] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
Acute kidney injury (AKI) is a common clinical syndrome characterized by a sudden decline in or loss of kidney function. AKI is not only associated with substantial morbidity and mortality but also with increased risk of chronic kidney disease (CKD). AKI is classically defined and staged based on serum creatinine concentration and urine output rates. The etiology of AKI is conceptually classified into three general categories: prerenal, intrarenal, and postrenal. Although this classification may be useful for establishing a differential diagnosis, AKI has mostly multifactorial, and pathophysiologic features that can be divided into different categories. Acute tubular necrosis, caused by either ischemia or nephrotoxicity, is common in the setting of AKI. The timely and accurate identification of AKI and a better understanding of the pathophysiological mechanisms that cause kidney dysfunction are essential. In this review, we consider various medical causes of AKI and summarize the most recent updates in the pathogenesis of AKI.
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Affiliation(s)
- Faruk Turgut
- Faculty of Medicine, Mustafa Kemal University, Antakya 31100, Hatay, Turkey
| | - Alaa S. Awad
- Division of Nephrology, University of Florida, Jacksonville, FL 32209, USA
| | - Emaad M. Abdel-Rahman
- Division of Nephrology, University of Virginia, Charlottesville, VA 22908, USA
- Correspondence:
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5
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Gadelkareem RA, Abdelraouf AM, El-Taher AM, Ahmed AI. Acute kidney injury due to bilateral malignant ureteral obstruction: Is there an optimal mode of drainage? World J Nephrol 2022; 11:146-163. [PMID: 36530794 PMCID: PMC9752243 DOI: 10.5527/wjn.v11.i6.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/29/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
There is a well-known relationship between malignancy and impairment of kidney functions, either in the form of acute kidney injury or chronic kidney disease. In the former, however, bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology. It warrants urgent drainage of the kidneys in emergency settings. However, there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients. This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature. Also, we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy. Despite the frequent trials for improving the success rates and functions of ureteral stents, placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction, especially in patients with advanced malignancy. However, the disturbance of the quality of life of those patients remains a major unresolved concern. Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed, the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors, including increased urine output, serum creatinine trajectory, and time-to-nadir serum creatinine after drainage.
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Affiliation(s)
- Rabea Ahmed Gadelkareem
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
| | - Ahmed Mahmoud Abdelraouf
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
| | - Ahmed Mohammed El-Taher
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
| | - Abdelfattah Ibrahim Ahmed
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
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6
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Formeck CL, Manrique-Caballero CL, Gómez H, Kellum JA. Uncommon Causes of Acute Kidney Injury. Crit Care Clin 2022; 38:317-347. [DOI: 10.1016/j.ccc.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kbirou A, Sayah M, Sounni F, Zamd M, Benghanem M, Dakir M, Debbagh A, Aboutaib R. Obstructive oligo-anuria revealing pelvic gynecological cancers, analysis of a series of 102 cases. Ann Med Surg (Lond) 2022; 75:103332. [PMID: 35198181 PMCID: PMC8851286 DOI: 10.1016/j.amsu.2022.103332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- A. Kbirou
- Urology Department, Ibn Rochd University Hospital Center, Casablanca, Morocco
- Corresponding author.
| | - M. Sayah
- Department of Nephrology, hemodialysis and kidney transplantation, Ibn Rochd University Hospital Center, CASABLANCA, Morocco
| | - F. Sounni
- Department of Nephrology, hemodialysis and kidney transplantation, Ibn Rochd University Hospital Center, CASABLANCA, Morocco
| | - M. Zamd
- Department of Nephrology, hemodialysis and kidney transplantation, Ibn Rochd University Hospital Center, CASABLANCA, Morocco
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, Morocco
| | - M.G. Benghanem
- Department of Nephrology, hemodialysis and kidney transplantation, Ibn Rochd University Hospital Center, CASABLANCA, Morocco
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, Morocco
| | - M. Dakir
- Urology Department, Ibn Rochd University Hospital Center, Casablanca, Morocco
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, Morocco
| | - A. Debbagh
- Urology Department, Ibn Rochd University Hospital Center, Casablanca, Morocco
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, Morocco
| | - R. Aboutaib
- Urology Department, Ibn Rochd University Hospital Center, Casablanca, Morocco
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, Morocco
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Athuraliya N, Etherton-Beer C. Health in Men Study: is frailty a predictor of medication-related hospitalization? QJM 2022; 115:84-90. [PMID: 33313927 DOI: 10.1093/qjmed/hcaa324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Older adults are at high risk of medication-related hospitalizations. Frailty is a phenotype commonly observed in older people due to declining physiological functions. AIM To examine the association of frailty with medication-related hospitalization among community dwelling older men. METHODS A prospective observational cohort study was conducted among community dwelling older men (mean age 75.6 years SD 5.9) from Western Australia (4324) who participated in the Health in Men Study. Participants were followed-up at 12 and 24 months to determine adverse drug event-related hospitalization, hospitalizations for other causes and mortality. RESULTS AND DISCUSSION The prevalence of frailty was 13.2%. At baseline, frailty was associated with exposure to polypharmacy, potentially inappropriate medication use and potential adverse drug-drug interactions with unadjusted odds ratios; [4.13 (3.48-4.89) P < 0.001], [2.46 (1.91-3.17) P < 0.001], [3.85 (3.03-4.90) P < 0.001], respectively. In unadjusted models, frail men were more likely to have non-accidental falls [OR 3.16 (2.51-3.99) P < 0.001], acute kidney injury [OR 3.37 (2.35-4.82) P < 0.001], ADE-related hospitalizations at 12 months [OR 6.83 (4.91-9.51)] and non-ADE-related hospitalizations [OR 2.63 (2.01-3.45)], or to be dead at 12 months [OR 2.97 (1.79-4.92)] and at 24 months [OR 3.14 (2.28-4.33)] when compared with non-frail men. After adjusting for age, living alone, cognitive decline, smoking status and comorbidity, frailty remained associated with ADE-related hospitalization [OR 3.60 (2.41-5.37)], non-ADE-related hospitalizations [OR 1.74 (1.29-2.36)] and death [OR 1.67 (1.15-2.41)]. CONCLUSION The study suggests that frailty is a predictor of medication-related harm with poorer clinical outcomes including mortality.
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Affiliation(s)
- N Athuraliya
- Department of Medicine, The Maitland Clinical School, Hunter New England Health, New South Wales, Australia
- The University of Newcastle, New South Wales, Australia
| | - C Etherton-Beer
- Western Australia Centre for Health and Ageing, The University of Western Australia 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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Fedi M, Bobot M, Torrents J, Gobert P, Magnant É, Knefati Y, Verhelst D, Lebrun G, Masson V, Giaime P, Santini J, Bataille S, Brunet P, Dussol B, Burtey S, Mancini J, Daniel L, Jourde-Chiche N. Kidney biopsy in very elderly patients: indications, therapeutic impact and complications. BMC Nephrol 2021; 22:362. [PMID: 34727880 PMCID: PMC8561868 DOI: 10.1186/s12882-021-02559-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients. METHODS Multicenter retrospective cohort study in the Aix-Marseille area: the results of KB and medical charts of all patients over 85 years biopsied between January 2010 and December 2018 were reviewed. RESULTS 104 patients were included. Median age was 87 years. Indications for KB were: acute kidney injury (AKI) in 69.2% of patients, nephrotic syndrome (NS) with AKI in 13.5%, NS without AKI in 12.5%, and proteinuria in 4.8%. Median serum creatinine was 262 μmol/L, 21% of patients required dialysis at the time of KB. Significant bleeding occurred in 7 (6.7%) patients, requiring blood cell transfusion in 4 (3.8%), and radiological embolization in 1 (1%). The most frequent pathological diagnoses were: non-diabetic glomerular diseases (29.8%, including pauci-immune crescentic glomerulonephritis in 9.6%), hypertensive nephropathy (27.9%), acute interstitial nephritis (16.3%), renal involvement of hematological malignancy (8.7%), and acute tubular necrosis (6.7%). After KB, 51 (49%) patients received a specific treatment: corticosteroids (41.3%), cyclophosphamide (6.7%), rituximab (6.7%), bortezomib (3.8%), other chemotherapies (3.8%). Median overall survival was 31 months. CONCLUSIONS KB can reveal a diagnosis with therapeutic impact even in very elderly patients. Severe bleeding was not frequent in this cohort, but KB may have not been performed in more vulnerable patients.
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Affiliation(s)
- Mathilde Fedi
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
| | - Mickaël Bobot
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Julia Torrents
- AP-HM, University Hospital of La Timone, Anatomical Pathology Laboratory, Marseille, France
| | - Pierre Gobert
- Rhône Durance Clinic, Medicine Department Avignon, Avignon, France
| | - Éric Magnant
- Private Hospital of Provence, Nephrology Department, Aix-en-Provence, France
| | - Yannick Knefati
- Hospital of Sainte Musse, Nephrology Department, Toulon, France
| | - David Verhelst
- Hospital Général Henri Duffaut, Nephrology Department, Avignon, France
| | - Gaëtan Lebrun
- Hospital of Aix en Provence, Nephrology Department, Aix-en-Provence, France
| | - Valérie Masson
- Polyclinic "des fleurs", Nephrology Department, Ollioules, France
| | - Philippe Giaime
- Phocaean Institute of Nephrology, Bouchard Clinic, ELSAN, Marseille, France
| | - Julien Santini
- Saint-Joseph Hospital, Nephrology Department, Marseille, France
| | - Stanislas Bataille
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
- Phocaean Institute of Nephrology, Bouchard Clinic, ELSAN, Marseille, France
| | - Philippe Brunet
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Bertrand Dussol
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Stéphane Burtey
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, University Hospital of la Timone, BIOSTIC Service, Marseille, France
| | - Laurent Daniel
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
- AP-HM, University Hospital of La Timone, Anatomical Pathology Laboratory, Marseille, France
| | - Noémie Jourde-Chiche
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France.
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France.
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Chen CM, Lin CY, Chung YP, Liu CH, Huang KT, Guan SS, Wu CT, Liu SH. Protective Effects of Nootkatone on Renal Inflammation, Apoptosis, and Fibrosis in a Unilateral Ureteral Obstructive Mouse Model. Nutrients 2021; 13:nu13113921. [PMID: 34836176 PMCID: PMC8621682 DOI: 10.3390/nu13113921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022] Open
Abstract
Nootkatone is one of the major active ingredients of Alpiniae oxyphyllae, which has been used as both food and medicinal plants for the treatment of diarrhea, ulceration, and enuresis. In this study, we aimed to investigate whether nootkatone treatment ameliorated the progression of chronic kidney diseases (CKD) and clarified its underlying mechanisms in an obstructive nephropathy (unilateral ureteral obstructive; UUO) mouse model. Our results revealed that nootkatone treatment preventively decreased the pathological changes and significantly mitigated the collagen deposition as well as the protein expression of fibrotic markers. Nootkatone could also alleviate oxidative stress-induced injury, inflammatory cell infiltration, and renal cell apoptotic death in the kidneys of UUO mice. These results demonstrated for the first time that nootkatone protected against the progression of CKD in a UUO mouse model. It may serve as a potential therapeutic candidate for CKD intervention.
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Affiliation(s)
- Chang-Mu Chen
- Division of Neurosurgery, Department of Surgery, College of Medicine and Hospital, National Taiwan University, Taipei 10051, Taiwan;
| | - Chen-Yu Lin
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan; (C.-Y.L.); (Y.-P.C.)
| | - Yao-Pang Chung
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan; (C.-Y.L.); (Y.-P.C.)
| | - Chia-Hung Liu
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11041, Taiwan;
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei 11041, Taiwan
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Kuo-Tong Huang
- Department of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 10051, Taiwan;
| | - Siao-Syun Guan
- Institute of Nuclear Energy Research, Atomic Energy Council, Taoyuan 32546, Taiwan;
| | - Cheng-Tien Wu
- Department of Nutrition, China Medical University, Taichung 406040, Taiwan
- Master Program of Food and Drug Safety, China Medical University, Taichung 406040, Taiwan
- Correspondence: (C.-T.W.); (S.-H.L.); Tel.: +886-4-22053366 (ext. 7525) (C.-T.W.); +886-2-23123456 (ext. 88605) (S.-H.L.)
| | - Shing-Hwa Liu
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan; (C.-Y.L.); (Y.-P.C.)
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
- Department of Paediatrics, National Taiwan University Hospital, Taipei 10051, Taiwan
- Correspondence: (C.-T.W.); (S.-H.L.); Tel.: +886-4-22053366 (ext. 7525) (C.-T.W.); +886-2-23123456 (ext. 88605) (S.-H.L.)
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11
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Secanho MS, Rajesh A, Menezes Neto BF, de Oliveira Maciel ABP, Chequim MM, Rocha C, Palhares Neto AA. Epidemiology of Burn-Related Morbidity and Mortality in Patients Over Eighty Years of Age. J Burn Care Res 2021; 43:1042-1047. [PMID: 34687314 DOI: 10.1093/jbcr/irab205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burns cause greater morbidity and mortality in older patients owing to the physiological changes and functional status declines with age. We sought to characterize the epidemiology of burn injuries in the patient population aged over eighty years. A retrospective analysis of all patients aged >80 years admitted to a tertiary burn center in Brazil over a 10-year period was conducted. Multiple parameters including comorbidities, body surface area(BSA) burned, intensive care unit(ICU) admissions, inhalation injury and revised Baux score were analyzed to assess association with mortality. 26 patients were identified. The overall mortality rate was 42.3%. The mortality rate increased with the TBSA, with 100% mortality at >20% total BSA involvement(p<0.001). Inhalation injury occurred in 3(11.5%) patients, all of whom suffered mortality(p<0.001). ICU admission was necessary for 14(53.8%) patients, out of which 11(78.6%) did not survive(p<0.001). The revised Baux score had a significant impact on the mortality, with higher values among patients who did not survive(89.2 ± 6.2 versus 110.7 ± 17.9,p < 0.001). Burns cause high mortality in the octogenarian and nonagenarian populations. It is important to stratify patients at high risk, institute prompt treatment and discuss goals of care early on for optimal patient outcomes.
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Affiliation(s)
- Murilo Sagrbi Secanho
- Plastic Surgery Resident at Botucatu Medical School - São Paulo State University (UNESP)Discipline of Plastic Surgery - Department of Surgery and Orthopedic - Botucatu Medical School - São Paulo State University (UNESP)
| | - Aashish Rajesh
- Bachelor of Medicine and Bachelor of Surgery - General Surgery Resident at University of Texas - Department of Surgery - University of Texas Health Science Center at San Antonio
| | - Balduino Ferreira Menezes Neto
- Plastic Surgery Resident at Botucatu Medical School - São Paulo State University (UNESP)Discipline of Plastic Surgery - Department of Surgery and Orthopedic - Botucatu Medical School - São Paulo State University (UNESP)
| | | | | | | | - Aristides Augusto Palhares Neto
- Plastic Surgery at Botucatu Medical School - São Paulo State University (UNESP)Discipline of Plastic Surgery - Department of Surgery and Orthopedic - Botucatu Medical School - São Paulo State University (UNESP)
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12
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Jhee JH, Park JY, An JN, Kim DK, Joo KW, Oh YK, Lim CS, Kim YS, Han SH, Yoo TH, Kang SW, Lee JP, Park JT. Cumulative fluid balance and mortality in elderly patients with acute kidney injury requiring continuous renal-replacement therapy: a multicenter prospective cohort study. Kidney Res Clin Pract 2020; 39:414-425. [PMID: 33318341 PMCID: PMC7770993 DOI: 10.23876/j.krcp.20.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/10/2020] [Accepted: 08/12/2020] [Indexed: 11/05/2022] Open
Abstract
Background The effect of fluid balance on outcomes in elderly patients with acute kidney injury (AKI) requiring continuous renal-replacement therapy (CRRT) is not explained well. We investigated outcomes according to cumulative fluid balance (CFB) in elderly patients with AKI undergoing CRRT. Methods A total of 607 patients aged 65 years or older who started CRRT due to AKI were enrolled and stratified into two groups (fluid overload [FO] vs. no fluid overload [NFO]) based on the median CFB value for 72 hours before CRRT initiation. Propensity score-matching analysis was performed. Results The median age of included patients was 73.0 years and 60.0% of the population was male. The median 72-hour CFB value was 2,839.0 mL. The overall cumulative survival and 28-day survival rates were lower in the FO group than in the NFO group (P < 0.001 for both) and remained so after propensity score-matching. Furthermore, patients in the FO group demonstrated a higher overall mortality risk after adjustment for age, sex, systolic blood pressure, Charlson comorbidity index, Acute Physiology and Chronic Health Evaluation II score, serum albumin, creatinine, diuretic use, and mechanical ventilation status (hazard ratio, 1.38; 95% confidence interval, 1.13 to 1.89; P < 0.001). Among survivors, both the duration of CRRT and the total duration of hospitalization from CRRT initiation showed no difference between the FO and NFO groups. Conclusion A higher CFB value is associated with an increased risk of mortality in elderly patients with AKI requiring CRRT.
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Affiliation(s)
- Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jung Nam An
- Department of Critical Care Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
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Acute Kidney Injury Caused by Obstructive Nephropathy. Int J Nephrol 2020; 2020:8846622. [PMID: 33312728 PMCID: PMC7719507 DOI: 10.1155/2020/8846622] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/21/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury secondary to obstructive nephropathy is a frequent event that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on the morbidity and mortality in those affected. The obstruction in the urinary tract has a profound impact on kidney function due to damage produced by ischemic and inflammatory factors that have been associated with intense fibrosis. This pathology is characterized by its effects on the management of fluids, electrolytes, and the acid-base mechanisms by the renal tubule; consequently, metabolic acidosis, hyperkalemia, uremia, and anuria are seen during acute kidney injury due to obstructive nephropathy, and after drainage, polyuria may occur. Acute urine retention is the typical presentation. The diagnosis consists of a complete medical history and should include changes in urinary voiding and urgency and enuresis, history of urinary tract infections, hematuria, renal lithiasis, prior urinary interventions, and constipation. Imaging studies included tomography or ultrasound in which hydronephrosis can be seen. Management includes, in addition to drainage of the obstructed urinary tract system, providing supportive treatment, correcting all the metabolic abnormalities, and initiating renal replacement therapy when required. Although its recovery is in most cases favorable, it seems to be an undervalued event in nephrology and urology. This is because it is mistakenly believed that the resolution and recovery of kidney function is complete once the urinary tract is unobstructed. It can have serious kidney sequelae. In this review, we report the epidemiology, incidence, pathophysiological mechanisms, diagnosis, and treatment of acute kidney injury due to obstructive nephropathy.
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Clinical characteristics and cost of hospital stay of octogenarians and nonagenarians in intensive care nephrology unit. Int Urol Nephrol 2020; 53:147-153. [PMID: 32949335 DOI: 10.1007/s11255-020-02647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE As the population gets older, the elderly and very elderly patients are increasingly been treated in nephrology intensive care units (ICU). In this study we evaluated the characteristics and outcomes of the octogenarians (80-89 years old), nonagenarians (≥ 90 years old) and compared them with elderly (65-79 years old) patients treated in nephrology ICU. METHODS Eighteen nonagenarians, 70 octogenarians and 88 elderly patients were included in the study. Indication for hospitalization, presence of comorbid diseases, and requirement for acute dialysis treatment were investigated. Need for mechanical ventilation, vasopressors, central venous catheterization, urinary catheterization, anticoagulation, and transfusion of blood products were evaluated. Mortality rate and hospital cost were calculated. Data about survival at 1 month after discharge was collected. RESULTS Causes of hospitalization, need for dialysis treatment, mechanical ventilation, vasopressors, central venous catheterization, urinary catheterization, anticoagulation, and transfusion of blood products were not different between age groups. Diabetes mellitus and malignancy were more frequent in elderly, whereas dementia/Alzheimer's disease was more common in nonagenarians. Although, mortality in ICU was increased as the age increased, it was statistically insignificant. However, 1 month mortality rate after discharge from hospital was increased especially in nonagenarians. In nonagenarians infection, whereas in octogenarians need for dialysis treatment, were related with mortality. Length of intensive care stay and hospital cost did not differ between age groups. CONCLUSION Length of nephrology intensive care stay, mortality rate and hospital cost did not differ for very elderly age groups, but mortality risk was higher for nonagenarians after discharge from hospital.
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15
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Li Q, Zhao M, Zhou F. Hospital-acquired acute kidney injury in very elderly men: clinical characteristics and short-term outcomes. Aging Clin Exp Res 2020; 32:1121-1128. [PMID: 31183748 PMCID: PMC7260277 DOI: 10.1007/s40520-019-01196-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/03/2019] [Indexed: 01/20/2023]
Abstract
Objectives We explored the risk factors for, and the clinical characteristics of, acute kidney injury (AKI), and the causes of death 28 days after such injury, in very elderly men. Methods This was a retrospective cohort study using data from the Geriatric Department of the Chinese PLA General Hospital. A total of 3464 elderly patients (≥ 75 years) were enrolled from January 2007 to December 2015. All patients were followed for 28 days or until death after AKI. Results In total, 668 patients (39.0%) developed AKI, and 623 men were included for the final analysis. The median age was 87 years. The 28-day mortality rate was 25.7%. The AKI etiologies were infections (39.6%), hypovolemia (23.8%), cardiovascular events (15.9%), nephrotoxicity (12.0%), and surgery (7.1%). Multiple organ dysfunction syndrome (46.4%) and pulmonary infection (22.5%) were the principal causes of death. Multivariate analysis revealed that time for AKI to develop (HR = 0.865; 95% CI 0.799–0.937; P < 0.001), low mean arterial pressure (HR = 0.970; 95% CI 0.958–0.981; P < 0.001), low serum prealbumin (HR = 0.924; 95% CI 0.894–0.955; P < 0.001) level, oliguria (HR = 2.261; 95% CI 1.424–3.590; P = 0.001), mechanical ventilation (HR = 1.492; 95% CI 1.047–2.124; P = 0.027), blood urea nitrogen (HR = 1.037; 95% CI 1.025–1.049; P < 0.001) level, magnesium (HR = 2.512; 95% CI 1.243–5.076; P = 0.010) level, and more severe AKI stages (stage 2: HR = 3.709; 95% CI 1.926–7.141; P < 0.001 and stage 3: HR = 5.660; 95% CI 2.990–10.717; P < 0.001) were independent risk factors for 28-day mortality. Conclusions The incidence of AKI increases significantly as age advanced. Identification of risk factors might lead to more intensive monitoring and early prevention, and might improve AKI patients’ outcomes in the very elderly.
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Affiliation(s)
- Qinglin Li
- Department of Critical Care Medicine, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Meng Zhao
- Department of Clinical Data Repository, Chinese PLA General Hospital, Beijing, 100853 China
| | - Feihu Zhou
- Department of Critical Care Medicine, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
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16
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Duarte I, Gameiro J, Resina C, Outerelo C. In-hospital mortality in elderly patients with acute kidney injury requiring dialysis: a cohort analysis. Int Urol Nephrol 2020; 52:1117-1124. [PMID: 32372303 DOI: 10.1007/s11255-020-02482-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine risk factors for in-hospital mortality in elderly patients with acute kidney injury (AKI) requiring dialysis. INTRODUCTION AKI requiring dialysis is frequent in elderly and is associated with an increased intra-hospital mortality. With the growing number of older individuals among hospitalized patients with AKI demands a thorough investigation of the factors that contribute to their mortality to improve outcomes. METHODS We performed a retrospective analysis of patients older than 80 years, admitted due to AKI requiring dialysis between January 2016 and December 2017. Patients who need intensive-care units (ICU) admission were excluded. The primary outcome was all-cause in-hospital mortality. RESULTS A total of 154 patients were evaluated. The mean age was 85.3 ± 4.0 years and 76 patients (49.4%) were male. The overall mortality rate was 26.6%. On the multivariate analysis, serum albumin (OR 0.42 [95% CI 0.21-0.85], p 0.016), C reactive protein/albumin ratio (OR 1.04 [95% CI 0.99-1.09], and renal function recovery (OR 018 [95% CI 0.49-0.65], p 0.009) were the factors associated with higher in-hospital mortality. CONCLUSIONS Lower albumin level, higher C reactive protein/albumin ratio at admission, and absence of renal function recovery are associated with increased in-hospital mortality's risk in elderly with acute kidney injury requiring dialysis.
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Affiliation(s)
- Inês Duarte
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Cristina Resina
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Cristina Outerelo
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
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17
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Medina-Liabres KRP, Kim S. Continuous renal replacement therapy in elderly with acute kidney injury. Korean J Intern Med 2020; 35:284-294. [PMID: 32131572 PMCID: PMC7061002 DOI: 10.3904/kjim.2019.431] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/13/2020] [Indexed: 12/29/2022] Open
Abstract
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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Affiliation(s)
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to Sejoong Kim, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7051 Fax: +82-31-787-4052 E-mail:
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18
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Abu Alfeilat M, Slotki I, Shavit L. Low blood pressure is associated with acute kidney injury development and mortality in octogenarians admitted to the emergency room. Geriatr Gerontol Int 2019; 19:874-878. [PMID: 31359614 DOI: 10.1111/ggi.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/02/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present study was to evaluate the incidence, risk factors, clinical characteristics and outcomes of acute kidney injury (AKI) in octogenarians admitted to the emergency room, and to compare these parameters with those in a younger group of patients admitted in the same period. METHODS This is a prospective, observational, single-center study that enrolled adult patients admitted to the emergency room of Shaare Zedek Medical Center, Jerusalem, Israel. Patients were stratified by age (≥80 years or <80 years) and followed up prospectively until discharge. The incidence of AKI, in-hospital mortality and duration of hospital stay were recorded. RESULTS Of 319 patients, 128 were octogenarians (mean age 86.7 years, range 80-105 years) and 191 were younger (mean age 60.6 years, range 18-79 years). The incidence of AKI and in-hospital mortality was significantly higher in octogenarians (16.4% vs 12.6%, P = 0.039 and 15.6% vs 3.1%, P = 0.001, respectively). In multivariate analysis, only low systolic blood pressure at admission in octogenarians (P = 0.002), and a history of chronic kidney disease (P < 0.001) and hypoalbuminemia (P = 0.001) in the younger patients were independent risk factors for AKI. CONCLUSION The present results confirm the observation that AKI is common in octogenarians. We identified systolic blood pressure as the only independent variable associated with AKI in octogenarians. However, the role of therapeutic strategies aimed to increase systolic blood pressure and diminish complications in octogenarians remains to be elucidated. Geriatr Gerontol Int 2019; 19: 874-878.
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Affiliation(s)
- Mohsen Abu Alfeilat
- Institute of Adult Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Itzchak Slotki
- Institute of Adult Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Linda Shavit
- Institute of Adult Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
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Kotani Y, Fujii T, Uchino S, Doi K. Modification of sequential organ failure assessment score using acute kidney injury classification. J Crit Care 2019; 51:198-203. [PMID: 30878015 DOI: 10.1016/j.jcrc.2019.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/06/2019] [Accepted: 02/25/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess the predictive validity of a modified Sequential Organ Failure Assessment (SOFA) score, of which the renal component was replaced with Kidney Disease Improving Global Outcomes (KDIGO) classification of Acute Kidney Injury (AKI). MATERIALS AND METHODS Using a prospective cohort study on AKI in Japan, we replaced the renal component of SOFA score with AKI stages according to the KDIGO criteria except that initiation of renal replacement therapy was assigned four points. We assessed the predictive validity of KDIGO-based SOFA score for hospital and ICU mortality by comparing the areas under the receiver operating characteristic curve (AUC) derived from logistic regression models with that of the original SOFA score. RESULTS 2292 patients were registered. Overall hospital mortality was 11.6%, and ICU mortality was 5.1%. KDIGO-based SOFA score was moderately correlated with APACHE II score (rho = 0.476). The AUC for hospital and ICU mortality of KDIGO-based and the original SOFA score were 0.749 vs 0.745 (p = .393) and 0.790 vs 0.791 (p = .900). CONCLUSIONS The prognostic performance of KDIGO-based SOFA score was not superior but comparable to that of the original SOFA score.
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Affiliation(s)
- Yuki Kotani
- Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, 4-20, Komatsubara-dori, Wakayama, Japan; Department of Intensive Care Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Japan.
| | - Tomoko Fujii
- Department of Epidemiology and Preventive Medicine, Kyoto University Graduate School of Medicine, Yoshida Hon-machi, Sakyo-ku, Kyoto, Japan; Japan Society for the Promotion of Science. 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, Japan.
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anaesthesiology, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Khalil MAM, Awan S, Azmat R, Khalil MAU, Naseer N, Tan J. Factors Affecting Inpatient Mortality in Elderly People with Acute Kidney Injury. ScientificWorldJournal 2018; 2018:2142519. [PMID: 29853800 PMCID: PMC5960515 DOI: 10.1155/2018/2142519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/30/2018] [Accepted: 03/25/2018] [Indexed: 11/18/2022] Open
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.
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Affiliation(s)
| | - Safia Awan
- Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | - Jackson Tan
- RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
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21
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Fang G, Annis IE, Farley JF, Mahendraratnam N, Hickson RP, Stürmer T, Robinson JG. Incidence of and Risk Factors for Severe Adverse Events in Elderly Patients Taking Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers after an Acute Myocardial Infarction. Pharmacotherapy 2017; 38:29-41. [PMID: 29059475 DOI: 10.1002/phar.2051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE To assess the incidence of and risk factors associated with severe adverse events in elderly patients who used angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) after an acute myocardial infarction (AMI). DESIGN Retrospective cohort study. DATA SOURCES Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse (Medicare service claims database), American Community Survey of the U.S. Census Bureau, and Multum Lexicon Drug database. PATIENTS A total of 101,588 eligible Medicare fee-for-service beneficiaries 66 years or older, who were hospitalized for AMI between January 1, 2008, and December 31, 2009, and used ACEIs or ARBs within 30 days after discharge. MEASUREMENTS AND MAIN RESULTS Primary outcomes were hospitalizations for acute renal failure (ARF) and hyperkalemia. The secondary outcome was discontinuation or suspension of ACEI/ARB therapy after a visit to a health care provider. The primary risk factors of interest were age, sex, race/ethnicity, and chronic kidney disease (CKD). Cumulative incidence curves and multivariable Fine-Gray proportional hazards models with 95% confidence intervals (CIs) were used with death as a competing risk in both intention-to-treat (ITT) and as-treated (AT) analyses. In the study cohort, 2.8% experienced ARF, 0.5% experienced hyperkalemia, and 63.7% discontinued ACEI/ARB therapy within 1 year after hospital discharge. Approximately half of the incidence of ARF and hyperkalemia occurred within 6 months after hospital discharge, but the cumulative incidence increased after 6 months. Patients older than 85 years had a higher rate of ARF (ITT hazard ratio [HR] 1.15, 95% CI 1.04-1.28) and hyperkalemia (ITT HR 1.33, 95% CI 1.05-1.68) compared with those aged 65-74 years. Patients with baseline CKD had higher rates of ARF (ITT HR 1.61, 95% CI 1.42-1.82), hyperkalemia (ITT HR 1.41, 95% CI 1.11-1.77), and ACEI/ARB therapy discontinuation or suspension (ITT HR 1.05, 95% CI 1.02-1.09). CONCLUSION We found a low incidence of ARF and hyperkalemia in elderly patients treated with ACEIs or ARBs after AMI hospitalization. However, a high rate of treatment discontinuation might prevent a higher rate of occurrence of these events. Long-term careful monitoring of severe adverse events and timely discontinuation of ACEIs or ARBs among elderly patients with advancing age and CKD after an AMI is warranted in clinical practice.
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Affiliation(s)
- Gang Fang
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joel F Farley
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirosha Mahendraratnam
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ryan P Hickson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Til Stürmer
- Department of Epidemiology, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer G Robinson
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa.,Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
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Silveira Santos CGD, Romani RF, Benvenutti R, Ribas Zahdi JO, Riella MC, Mazza do Nascimento M. Acute Kidney Injury in Elderly Population: A Prospective Observational Study. Nephron Clin Pract 2017; 138:104-112. [PMID: 29169177 DOI: 10.1159/000481181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/31/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS Acute kidney injury (AKI) has been reported as a recognized condition among the elderly population; however, its clinical epidemiology is still poorly evaluated. We propose to evaluate the epidemiological profile of AKI in hospitalized elderly patients and the variables associated with renal replacement therapy (RRT) dependency at discharge after an episode of AKI. METHODS This prospective observational study enrolled 286 elderly patients (aged ≥60 years), who had a diagnosis of AKI and were admitted to a tertiary care hospital. Clinical data were analyzed, which included RRT indication, referral time to nephrologist support, standby period in the emergency care units (ECU) before a transfer to an intensive care unit, staff criteria used to indicate palliative care, and the incidence of patients who stayed on chronic dialysis for at least 6 months after discharge. RESULTS The overall hospital mortality was 56.3%. Acute Kidney Injury Network (AKIN) 3 at the time of admission was significantly higher in patients who underwent RRT. Intrinsic AKI (p < 0.001), AKIN 3 (p < 0.001), RRT (p < 0.001), and increased length of stay in ECUs (p = 0.01) all had a significantly higher prevalence among non-survivors. On multivariate analysis, however, only renal aetiology (intrinsic AKI) was independently associated with mortality (OR 2.88; 95% CI [1.29-6.13]). Approximately 85% of the discharged patients (n = 125) were dialysis free and 36.4% of them who had a previous diagnosis of chronic kidney disease (CKD) upon admission had a worse renal function. Age, AKIN 3, RRT, prior history of CKD, diabetes mellitus, and the number of hemodialysis sessions showed to have an impact on dialysis dependence. Furthermore, 24 of 161 patients who had a dialysis indication were placed on palliative care. CONCLUSIONS The severity of AKI and the need for RRT were risk factors for mortality and dependence on dialysis. Antecedents of CKD seem to be associated with a poor renal outcome following an AKI episode. Starting RRT had an impact on the clinical decision to enroll these patients into palliative care.
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Affiliation(s)
- Cássia Gomes da Silveira Santos
- Post-Graduate Internal Medicine Program of Hospital de Clínicas do Paraná, UFPR, Curitiba, Brazil.,Department of Nephrology, Hospital do Idoso Zilda Arns, Curitiba, Brazil
| | - Rafael Fernandes Romani
- Department of Nephrology, Hospital do Idoso Zilda Arns, Curitiba, Brazil.,ProRenal Foundation Brazil, Curitiba, Brazil
| | - Ricardo Benvenutti
- Department of Nephrology, Hospital do Idoso Zilda Arns, Curitiba, Brazil
| | | | | | - Marcelo Mazza do Nascimento
- Post-Graduate Internal Medicine Program of Hospital de Clínicas do Paraná, UFPR, Curitiba, Brazil.,Department of Nephrology, Hospital do Idoso Zilda Arns, Curitiba, Brazil.,ProRenal Foundation Brazil, Curitiba, Brazil
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Vargas N, Tibullo L, Landi E, Carifi G, Pirone A, Pippo A, Alviggi I, Tizzano R, Salsano E, Di Grezia F, Vargas M. Caring for critically ill oldest old patients: a clinical review. Aging Clin Exp Res 2017; 29:833-845. [PMID: 27761759 DOI: 10.1007/s40520-016-0638-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022]
Abstract
Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity. The aim of this review was to focus on all these aspects with an emphasis on some intensive procedures such as mechanical ventilation, noninvasive mechanical ventilation, cardiopulmonary resuscitation, renal replacement therapy, hemodynamic support, evaluation of delirium and malnutrition in this heterogeneous frail ICU population.
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Affiliation(s)
- Nicola Vargas
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy.
| | - Loredana Tibullo
- Medicine Ward, Medicine Department, "San Giuseppe Moscati" Hospital, via Gramsci, 81031, Aversa, CE, Italy
| | - Emanuela Landi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Giovanni Carifi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Alfonso Pirone
- Clinical Nutrition and Dietology Unit, Medicine Department, Azienda Ospedaliera di Rilievo Nazionale e di alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Antonio Pippo
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Immacolata Alviggi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Renato Tizzano
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Elisa Salsano
- Department of Clinical Disease and Internal Medicine, Federico II University of Naples, via Pansini, 80121, Naples, Italy
| | - Francesco Di Grezia
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Maria Vargas
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini, 89121, Naples, Italy
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Turgutalp K, Bardak S, Horoz M, Helvacı I, Demir S, Kiykim AA. Clinical outcomes of acute kidney injury developing outside the hospital in elderly. Int Urol Nephrol 2017; 49:113-121. [PMID: 27704319 DOI: 10.1007/s11255-016-1431-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/26/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE Although various studies have improved our knowledge about the clinical features and outcomes of acute kidney injury developing in the hospital (AKI-DI) in elderly subjects, data about acute kidney injury developing outside the hospital (AKI-DO) in elderly patients (age ≥ 65 years) are still extremely limited. This study was performed to investigate prevalence, clinical outcomes, hospital cost and related factors of AKI-DO in elderly and very elderly patients. METHODS We conducted a prospective, observational study in patients (aged ≥ 65 years) who were admitted to our center between May 01, 2012, and May 01, 2013. Subjects with AKI-DO were divided into two groups as "elderly" (group 1, 65-75 years old) and "very elderly" (group 2, >75 years old). Control group (group 3) consisted of the hospitalized patients aged 65 years and older with normal serum creatinine level. In-hospital outcomes and 6-month outcomes were recorded. Rehospitalization rate within 6 months of discharge was noted. Hospital costs and mortality rates of each group were investigated. Risk factors for AKI-DO were determined. RESULTS The incidence of AKI-DO that required hospitalization in elderly and very elderly patients was 5.8 % (136/2324) and 11 % (100/905), respectively (p < 0.001), with an overall incidence of 7.3 % (236/3229). Chronic kidney disease (CKD) was developed in 43.4 % of group 1 and 67 % of group 2 within the 6 months of discharge (p < 0.001). Progression to CKD was significantly lower in the control group than in groups 1 and 2 (p < 0.001). Mortality rates for groups 1, 2 and 3 were 23.5 % (n = 32), 31 % (n = 31) and 4.2 % (n = 8), respectively (p < 0.05). Rehospitalization rate within the 6 months of discharge for the groups with AKI-DO was higher than for the control group (p < 0.001). Hospital cost of groups 1 and 2 was significantly higher than that of the control group (p < 0.001). Nonsteroidal anti-inflammatory drugs (NSAIDs) (OR: 6.839, 95 % CI = 4.392-10.648), angiotensin-converting enzyme inhibitors (ACEI) (OR: 7.846, 95 % CI = 5.161-11.928), angiotensin receptor blockers (ARB) (OR: 6.466, 95 % CI = 4.813-8.917), radiocontrast agents (OR: 8.850, 95 % CI = 5.857-13.372), hypertension (OR: 4.244, 95 % CI = 2.729-6.600), diabetes mellitus (OR: 2.303, 95 % CI = 1.411-3.761), heart failure (OR: 3.647, 95 % CI = 2.276-5.844) and presence of infection (OR: 3.149, 95 % CI = 1.696-5.845) were found as the risk factors for AKI-DO in elderly patients (p < 0.001 for all). Patients with AKI-DO had higher 6-month mortality rate (HR 1.721, 95 % CI: 1.451-2.043, p < 0.001). Mortality risk increased 0.519 times at 20th day. CONCLUSIONS The incidence of AKI-DO requiring hospitalization is higher in very elderly patients than elderly ones, especially in male gender. Use of ACEI, ARB, NSAID and radiocontrast agents is the main risk factors for the development of AKI-DO in the elderly.
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Affiliation(s)
- K Turgutalp
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Mersin University, 33079, Mersin, Turkey.
| | - S Bardak
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Mersin University, 33079, Mersin, Turkey
| | - M Horoz
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Istanbul Bahcesehir University, Istanbul, Turkey
| | - I Helvacı
- Silifke School of Applied Technology and Management, Department of Business Information Management and Biostatistic, Mersin University, Silifke, Mersin, Turkey
| | - S Demir
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Mersin University, 33079, Mersin, Turkey
| | - A A Kiykim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Mersin University, 33079, Mersin, Turkey
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Li Q, Zhao M, Du J, Wang X. Earlier nephrology consultation may not be associated with improved short-term survival of acute kidney injury in very elderly men. Clin Interv Aging 2016; 12:11-18. [PMID: 28031705 PMCID: PMC5182033 DOI: 10.2147/cia.s120819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives A delayed nephrology consultation (NC) may be associated with a poor prognosis in acute kidney injury (AKI) patients. The aims of this study were to compare the clinical and laboratory characteristics of elderly AKI patients evaluated and not evaluated by nephrologists and to generate a hypothesis regarding the relationship between the timing of the NC and 90-day outcomes. Methods From 2007 to 2015, this study explored associations among the presence and timing of NC with the non-intensive care unit stay and 90-day mortality in elderly AKI patients at the Geriatric Department of the Chinese People’s Liberation Army General Hospital. Early NC and delayed NC were defined as NCs performed before and 2 days after the day of AKI diagnosis, respectively. Multivariable logistic regression was used to adjust for confounding and selection bias. Results In total, 623 patients were included for the final analysis, of whom 162 (26%) were evaluated by nephrologists. The 90-day mortality rate was 33.2%, and dialysis was required in 1.4% of patients (9/623). Multivariable analysis showed that a higher prevalence of preexisting chronic obstructive pulmonary disease, AKI diagnosis time, peak serum creatinine level, blood urea nitrogen level, AKI stage, and mortality was associated with the NC. The NC was delayed (>48 h) in 59 patients (36.4%) (median time to consultation, 4 days). The median AKI diagnosis time, presence of oliguria, uric acid level, and a more severe AKI stage were associated with delayed consultation. Moreover, delayed consultation presented a similar 90-day mortality rate to that of an early NC (50.8% vs 44.7%, respectively, P=0.448). Conclusion In very elderly AKI patients, those evaluated by nephrologists have more severe AKI and a higher mortality rate than those not evaluated by nephrologists. An earlier NC may not be associated with improved 90-day survival.
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Affiliation(s)
| | - Meng Zhao
- Department of Clinical Data Repository, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jing Du
- Department of Geriatric Nephrology
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Park JY, An JN, Jhee JH, Kim DK, Oh HJ, Kim S, Joo KW, Oh YK, Lim CS, Kang SW, Kim YS, Park JT, Lee JP. Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: a multicenter prospective cohort study. Crit Care 2016; 20:260. [PMID: 27526933 PMCID: PMC4986348 DOI: 10.1186/s13054-016-1437-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/26/2016] [Indexed: 11/29/2022] Open
Abstract
Background Continuous renal replacement therapy (CRRT) is essential in the management of critically ill patients with acute kidney injury (AKI). However, the optimal timing for initiating CRRT remains controversial, especially in elderly patients. Therefore, we investigated the outcomes of early CRRT initiation in elderly patients with AKI. Methods A total of 607 patients ≥65 years of age who started CRRT due to AKI between August 2009 and December 2013 were prospectively enrolled. They were divided into two groups based on the median 6-hour urine output immediately before CRRT initiation. Propensity score matching was used to compare the overall survival rate, CRRT duration, and hospitalization duration. Results The median age of both groups was 73.0 years, and 60 % of the patients were male. The most common cause of AKI was sepsis. In the early CRRT group, the mean arterial pressure was higher, but the prothrombin time and total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were lower. The overall cumulative survival rate was higher in the early CRRT group (log-rank P < 0.01). Late CRRT initiation was associated with a higher mortality rate than early initiation after adjusting for age, sex, the Charlson comorbidity index, systolic arterial pressure, prothrombin time, the total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels, cumulative fluid balance and diuretic use (hazard ratio, 1.35; 95 % confidence interval 1.06, 1.71, P = 0.02). Following propensity score matching, patient survival was significantly better in the early CRRT group than in the late CRRT group (P < 0.01). The total duration of hospitalization from the start of CRRT was shorter among the survivors when CRRT was started earlier (26.7 versus 39.1 days, P = 0.04). Conclusion A better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill, elderly patients. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1437-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggido, 10326, Korea
| | - Jung Nam An
- Department of Critical Care Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Korea
| | - Jong Hyun Jhee
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Korea
| | - Chun-Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Korea.
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Abstract
Several anatomic changes and physiologic alterations occur in the aging kidney, awareness of which is essential for the early recognition of acute kidney injury (AKI) to improve outcomes in hospitalized geriatric patients. There are no unique diagnostic methods or treatment modalities in the care of the geriatric patient with AKI. Therapy is mainly supportive, and the full spectrum of treatment options, including renal replacement therapy (RRT), should not be withheld from a patient based on age. More studies need to be performed to determine the optimal timing, intensity, and modality of RRT in the geriatric population.
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Affiliation(s)
- Anthony J Baldea
- Division of Trauma, Critical Care and Burns, Loyola University Medical Center, 2160 South First Avenue, EMS Building, Room 3279, Maywood, IL 60153, USA.
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Chao CT, Tsai HB, Lin YF, Ko WJ. Acute kidney injury in the elderly: Only the tip of the iceberg. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jcgg.2013.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Commereuc M, Rondeau E, Ridel C. [Acute kidney injury in elderly patient: Diagnostic and therapeutic aspects]. Presse Med 2014; 43:341-7. [PMID: 24560978 DOI: 10.1016/j.lpm.2013.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/08/2013] [Accepted: 07/08/2013] [Indexed: 10/25/2022] Open
Abstract
Acute renal failure in elderly patient is a public health problem. It is worsen by physiological status and anatomical changes associated with age, polymedication and chronic diseases. The etiologies of acute renal failure in the elderly are the same as in adults. Their distribution is specific with a large proportion of obstructive acute renal failure. The diagnostic and therapeutic strategies are the same as for young adults; the injection of iodinated-contrast should be avoided. Therapeutic strategies are discussed in terms of quality of life pre-morbid. Age is not considered a determinant of intensive treatment decisions. Renal replacement therapy in the elderly is not associated with excess mortality. Prevention of acute renal failure should be a permanent concern.
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Affiliation(s)
- Morgane Commereuc
- Hôpital Tenon, service d'urgences néphrologiques et transplantation rénale, 75020 Paris, France.
| | - Eric Rondeau
- Hôpital Tenon, service d'urgences néphrologiques et transplantation rénale, 75020 Paris, France
| | - Christophe Ridel
- Hôpital Tenon, service d'urgences néphrologiques et transplantation rénale, 75020 Paris, France
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Girshovich A, Vinsonneau C, Perez J, Vandermeersch S, Verpont MC, Placier S, Jouanneau C, Letavernier E, Baud L, Haymann JP. Ureteral obstruction promotes proliferation and differentiation of the renal urothelium into a bladder-like phenotype. Kidney Int 2013; 82:428-35. [PMID: 22513823 DOI: 10.1038/ki.2012.110] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The renal urothelium, the monolayered epithelium that covers the papilla, is the direct target of increased pressure during obstruction, yet most studies have mainly focused on tubules, fibroblasts, and inflammatory cells. We studied this epithelium in a unilateral ureteral obstruction mouse mode land found that it was disrupted and had broken tight junctions, enlarged intercellular space, with loss of apicaluroplakins, and marginal lumen desquamation. Shortly after obstruction these urothelial cells proliferated, peaking at day 2. By day 14, the renal urothelium was transformed into a multilayered barrier with newly synthesized uroplakins including the de novo induction of uroplakin II. This proliferation was found to be fibroblast growth factor (FGF)dependent. Renal urothelial cells constitutively express the FGF receptor 2, and obstruction activated the receptor by phosphorylation. Treatment with FGF receptor 2-antisense or vitamin A (an inhibitor of the MAP kinase in the FGFR2 pathway) decreased renal urothelial cell proliferation. Among known FGF receptor 2 ligands, only FGF7 was upregulated.Infusion of FGF7 into control mice caused the formation of a multilayered structure at 7 days, resembling the urothelium 14 days following obstruction. Thus, the pressure/stretching of renal monolayered urothelial cells is a very efficient trigger for proliferation, causing the formation of a bladder-like multistratified barrier with enhanced apical uroplakin plaques. Presumably, this ensures efficient barrier protection and repair.
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Affiliation(s)
- Alexey Girshovich
- UPMC et Inserm UMR_S 702, Remodelage et Réparation du Tissu Rénal, Paris, France.
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Cost-effectiveness of the Edwards SAPIEN transcatheter heart valve compared with standard management and surgical aortic valve replacement in patients with severe symptomatic aortic stenosis: A Canadian perspective. J Thorac Cardiovasc Surg 2013; 146:52-60.e3. [DOI: 10.1016/j.jtcvs.2012.06.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/22/2012] [Accepted: 06/12/2012] [Indexed: 11/24/2022]
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Stads S, Fortrie G, van Bommel J, Zietse R, Betjes MGH. Impaired kidney function at hospital discharge and long-term renal and overall survival in patients who received CRRT. Clin J Am Soc Nephrol 2013; 8:1284-91. [PMID: 23599403 DOI: 10.2215/cjn.06650712] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Critically ill patients with AKI necessitating renal replacement therapy (RRT) have high in-hospital mortality, and survivors are at risk for kidney dysfunction at hospital discharge. The objective was to evaluate the association between impaired kidney function at hospital discharge with long-term renal and overall survival. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Degree of kidney dysfunction in relation to long-term effects on renal survival and patient mortality was investigated in a retrospective cohort study of 1220 adults admitted to an intensive care unit who received continuous RRT between 1994 and 2010. RESULTS After hospital discharge, median follow-up of survivors (n=475) was 8.5 years (range, 1-17 years); overall mortality rate was 75%. Only 170 (35%) patients were discharged with an estimated GFR (eGFR) >60 ml/min per 1.73 m(2). Multivariate proportional hazards regression analysis demonstrated that age, nonsurgical type of admission, preexisting kidney disease, malignancy, and eGFR of 29-15 ml/min per 1.73 m(2) (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.01 to 2.58) and eGFR <15 ml/min per 1.73 m(2) (HR, 1.93; 95% CI, 1.23 to 3.02) at discharge were independent predictors of increased mortality. Renal survival was significantly associated with degree of kidney dysfunction at discharge. An eGFR of 29-15 ml/min per 1.73 m(2) (HR, 26.26; 95% CI, 5.59 to 123.40) and <15 ml/min per 1.73 m(2) (HR, 172.28; 95% CI, 37.72 to 786.75) were independent risk factors for initiation of long-term RRT. CONCLUSIONS Most critically ill patients surviving AKI necessitating RRT have impaired kidney function at hospital discharge. An eGFR <30 ml/min per 1.73 m(2) is a strong risk factor for decreased long-term survival and poor renal survival.
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Affiliation(s)
- Susanne Stads
- Department of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
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Hamdi A, Hajage D, Van Glabeke E, Belenfant X, Vincent F, Gonzalez F, Ciroldi M, Obadia E, Chelha R, Pallot JL, Das V. Severe post-renal acute kidney injury, post-obstructive diuresis and renal recovery. BJU Int 2012; 110:E1027-34. [PMID: 22583774 DOI: 10.1111/j.1464-410x.2012.11193.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The pathophysiology of post-renal acute kidney injury (PR-AKI), i.e. caused by urinary tract obstruction, has been extensively studied in animal models but clinical studies on this subject are outdated, and/or have focused on the mechanisms of 'post-obstructive diuresis' (POD), a potentially life-threatening polyuria that can develop after the release of obstruction. In severe PR-AKI, the risk of occurrence of POD is high. POD occurrence predicts renal recovery without the persistence of severe chronic kidney failure. In the present study, the occurrence of POD and the persistence of chronic renal sequelae could be predicted early from clinical variables at admission before the release of obstruction. OBJECTIVE • To identify predictors of post-obstructive diuresis (POD) occurrence or severe chronic renal failure (CRF) persistence after the release of urinary tract obstruction in the setting of post-renal acute kidney injury (PR-AKI). PATIENTS AND METHODS • Bi-centre retrospective observational study of all patients with PR-AKI treated in two intensive care units (ICUs) from 1998 to 2010. • Clinical, biological and imaging characteristics on admission and after the release of obstruction were analysed with univariate and, if possible, multivariate analysis to search for predictors of (i) occurrence of POD (diuresis >4 L/day) after the release of obstruction; (ii) persistence of severe CRF (estimated glomerular filtration rate <30 mL/min/1.73 m(2), including end-stage CRF) at 3 months. RESULTS • On admission, median (range) serum creatinine was 866 (247-3119) µmol/L. • POD occurred in 34 (63%) of the 54 analysable patients. On admission, higher serum creatinine (Odds ratio [OR] 1.002 per 1 µmol/L, 95% confidence interval [CI] 1.000-1.004, P = 0.004), higher serum bicarbonate (OR 1.36 per 1 mmol/L, 95% CI 1.13-1.65, P < 0.001), and urinary retention (OR 6.96, 95% CI 1.34-36.23, P = 0.01) independently predicted POD occurrence. • Severe CRF persisted in seven (21%) of the 34 analysable patients, including two (6%) cases of end-stage CRF. Predictors of severe CRF persistence after univariate analysis were: lower blood haemoglobin (P < 0.001) and lower serum bicarbonate (P = 0.03) on admission, longer time from admission to the release of obstruction (P = 0.01) and absence of POD (P = 0.04) after the release of obstruction. CONCLUSIONS • In severe PR-AKI treated in ICU, POD occurrence was a frequent event that predicted renal recovery without severe CRF. • POD occurrence or severe CRF persistence could be predicted early from clinical and biological variables at admission before the release of obstruction.
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Affiliation(s)
- Aïcha Hamdi
- Service de Réanimation Polyvalente Adulte, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
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37
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The kidney and the elderly: why does the risk increase? Int Urol Nephrol 2011; 44:625-32. [DOI: 10.1007/s11255-011-0063-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 09/20/2011] [Indexed: 12/19/2022]
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38
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Chronopoulos A, Rosner MH, Cruz DN, Ronco C. Acute kidney injury in elderly intensive care patients: a review. Intensive Care Med 2010; 36:1454-64. [DOI: 10.1007/s00134-010-1957-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 06/27/2010] [Indexed: 11/28/2022]
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Coca SG. Acute kidney injury in elderly persons. Am J Kidney Dis 2010; 56:122-31. [PMID: 20346560 DOI: 10.1053/j.ajkd.2009.12.034] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 12/11/2009] [Indexed: 11/11/2022]
Abstract
The incidence rate of acute kidney injury (AKI) is highest in elderly patients, who make up an ever-growing segment of the population at large. AKI in these patients is associated with an increased risk of short- and long-term death and chronic kidney disease, including end-stage renal disease. Whether AKI in older individuals carries a larger relative risk for these outcomes compared with younger individuals is unclear at this time. Other domains, such as health-related quality of life, may be mildly impacted on after an episode of AKI. No effective therapies for AKI currently are available for widespread use. However, because the incidence of AKI is highest in the elderly and the phenotype is not discernibly different from AKI in all populations, future randomized controlled trials of interventions for AKI should be performed in the elderly population.
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Affiliation(s)
- Steven G Coca
- Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA.
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40
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Yilmaz R, Erdem Y. Acute kidney injury in the elderly population. Int Urol Nephrol 2009; 42:259-71. [PMID: 19707882 DOI: 10.1007/s11255-009-9629-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 07/29/2009] [Indexed: 12/22/2022]
Abstract
The elderly population is more prone to acute kidney injury (AKI) than younger populations. Older patients have less renal reserve because of reduced glomerular filtration rates due to anatomic/functional changes, and concomitant diseases such as hypertension, diabetes, atherosclerosis, heart failure, ischemic renal disease, and obstructive uropathy. The risk of AKI may also increase as a result of aggressive diagnostic and therapeutic procedures, which include medical agents, radiology, and surgical intervention. AKI in the elderly has a multifactorial physiopathology due to different etiologies. Studies that have specifically compared prognosis of AKI in elderly versus young over the recent years suggest that age is a predictor of long-term outcome. In most cases, the treatment of AKI is similar for all age groups. The majority of critically ill patients with AKI will eventually need renal replacement therapy (RRT). The influence of RRT on renal outcome remains a subject of intense investigation and debate. Avoiding situations that could damage the kidney is an important strategy to prevent AKI development in the elderly, besides medical and interventional therapeutics.
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Affiliation(s)
- Rahmi Yilmaz
- School of Medicine, Nephrology Department, Hacettepe University, 06100, Ankara, Turkey
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41
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Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009; 53:961-73. [PMID: 19346042 DOI: 10.1053/j.ajkd.2008.11.034] [Citation(s) in RCA: 842] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 11/28/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in hospitalized patients. The impact of AKI on long-term outcomes is controversial. STUDY DESIGN Systematic review and meta-analysis. SETTING & PARTICIPANTS Persons with AKI. SELECTION CRITERIA FOR STUDIES MEDLINE and EMBASE databases were searched from 1985 through October 2007. Original studies describing outcomes of AKI for patients who survived hospital discharge were included. Studies were excluded from review when participants were followed up for less than 6 months. PREDICTOR AKI, defined as acute changes in serum creatinine level or acute need for renal replacement therapy. OUTCOMES Chronic kidney disease (CKD), cardiovascular disease, and mortality. RESULTS 48 studies that contained a total of 47,017 participants were reviewed; 15 studies reported long-term data for patients without AKI. The incidence rate of mortality was 8.9 deaths/100 person-years in survivors of AKI and 4.3 deaths/100 patient-years in survivors without AKI (rate ratio [RR], 2.59; 95% confidence interval, 1.97 to 3.42). AKI was associated independently with mortality risk in 6 of 6 studies that performed multivariate adjustment (adjusted RR, 1.6 to 3.9) and with myocardial infarction in 2 of 2 studies (RR, 2.05; 95% confidence interval, 1.61 to 2.61). The incidence rate of CKD after an episode of AKI was 7.8 events/100 patient-years, and the rate of end-stage renal disease was 4.9 events/100 patient-years. LIMITATIONS The relative risk for CKD and end-stage renal disease after AKI was unattainable because of lack of follow-up of appropriate controls without AKI. CONCLUSIONS The development of AKI, defined as acute changes in serum creatinine level, characterizes hospitalized patients at increased risk of long-term adverse outcomes.
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Affiliation(s)
- Steven G Coca
- Section of Nephrology, Yale University, West Haven, CT 06516, USA
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Abstract
Age-related changes in renal morphology and function cannot be regarded physiological. The number of glomeruli falls, sclerotic glomeruli and aglomerular arterioles develop. Besides tubular atrophy interstitial fibrosis is often seen, and the age-related vascular changes strongly affect the kidneys. Renal blood flow and GFR decrease, without concomitant changes in se-creatinine. Disorders of tubular transport manifest mainly in salt- and water-excretion and lead to hyposthenuria. The pathogenesis of these age-related changes is not fully understood. Nevertheless, such changes impair the excretory functions and the pharmacokinetics of drugs. In real chronic renal failure other functions (erythropoietin production, vitamin-D, Ca and P metabolism) are also impaired. Due to more frequent occurrence of systemic diseases (diabetes, hypertension, etc.) in the elderly, real chronic renal failure is also more common, and various forms of acute renal failure develop more easily.
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Affiliation(s)
- Endre Balázs
- Nagykanizsa Megyei Jogú Város Kórháza Gerontológiai Osztály Nagykanizsa
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Mittalhenkle A, Stehman-Breen CO, Shlipak MG, Fried LF, Katz R, Young BA, Seliger S, Gillen D, Newman AB, Psaty BM, Siscovick D. Cardiovascular risk factors and incident acute renal failure in older adults: the cardiovascular health study. Clin J Am Soc Nephrol 2008; 3:450-6. [PMID: 18256380 DOI: 10.2215/cjn.02610607] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Although the elderly are at increased risk for acute renal failure, few prospective studies have identified risk factors for acute renal failure in the elderly. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The associations of cardiovascular disease risk factors, subclinical cardiovascular disease, and clinical coronary heart disease with the risk for development of acute renal failure were examined in older adults in the Cardiovascular Health Study, a prospective cohort study of community-dwelling older adults. Incident hospitalized cases of acute renal failure were identified through hospital discharge International Classification of Diseases, Ninth Revision codes and confirmed through physician diagnoses of acute renal failure in discharge summaries. RESULTS Acute renal failure developed in 225 (3.9%) of the 5731 patients during a median follow-up period of 10.2 yr. In multivariate analyses, diabetes, current smoking, hypertension, C-reactive protein, and fibrinogen were associated with acute renal failure. Prevalent coronary heart disease was associated with incident acute renal failure, and among patients without prevalent coronary heart disease, subclinical vascular disease measures were also associated with acute renal failure: Low ankle-arm index (< or =0.9), common carotid intima-media thickness, and internal carotid intima-media thickness. CONCLUSIONS In this large, population-based, prospective cohort study, cardiovascular risk factors and both subclinical and clinical vascular disease were associated with incident acute renal failure in the elderly.
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Affiliation(s)
- Anuja Mittalhenkle
- Division of Nephrology & Hypertension, Department of Medicine, Mail Code MQ360, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA.
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Wang Y, Cui Z, Fan M. Hospital-acquired and community-acquired acute renal failure in hospitalized Chinese: a ten-year review. Ren Fail 2007; 29:163-8. [PMID: 17365931 DOI: 10.1080/08860220601095918] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To investigate the difference between hospital-acquired acute renal failure (HA-ARF) and community-acquired acute renal failure (CA-ARF) in hospitalized Chinese. METHODS The diagnosis of ARF in Peking University Third Hospital from January 1994 to December 2003 was reconfirmed and subdivided into AC-ARF and HA-ARF. Data of epidemiology, etiology, prognosis, and associated factors were analyzed. Single-variable analysis and multivariate logistic regression analyses were performed to investigate the correlation between clinical features and prognosis respectively. Results among 205 reconfirmed CA-ARF had a predominance of 59.5%, but HA-ARF demonstrated an increase by 1.06 during the last five years (p = 0.003). In all, 70.5% CA-ARF was diagnosed in internal medicine with 45.9% in department of nephrology, whereas 59.1% HA-ARF was diagnosed in surgical department with 51.8% in ICU. Distribution difference among departments was significant (p < 0.01). Further, 90.2% CA-ARF was associated with a single factor, while 36.1% of HA-ARF had two or more causes (p < 0.01). Also, 26.5% HA-ARF and 18.9% CA-ARF was drug-associated (p > 0.05) while 24.1% HA-ARF and 12.3% CA-ARF was infection-associated (p < 0.01). HA-ARF vs. CA-ARF was 62.7% vs. 23.0% in mortality (p < 0.01), 0.54 +/- 0.24 vs. 0.27 +/- 0.18 in ATI-ISS index (p < 0.01) and 19.6 +/- 4.9 vs. 15.7 +/- 5.6 in APACHE II scores (p < 0.01). MODS and SIRS were common independent predictors with oliguria for HA-ARF and advanced age for CA-ARF, respectively. CONCLUSIONS In hospitalized Chinese during the last ten years, CA-ARF was still predominant with simpler cause and lower mortality, whereas HA-ARF was increasing with more complicated cause and higher mortality.
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Affiliation(s)
- Yue Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, PR China.
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45
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Hsieh CW, Chen HH. Continuous Renal Replacement Therapy for Acute Renal Failure in the Elderly. INT J GERONTOL 2007. [DOI: 10.1016/s1873-9598(08)70023-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Szegedi J. [Renal insufficiency caused by medicines, diagnostic processes, toxins]. Orv Hetil 2007; 148:99-103. [PMID: 17289612 DOI: 10.1556/oh.2007.27946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The significance of acute renal insufficiency has grown in the past decade. The increase in the prevalence and mortality of the disease has played a role in this tendency. When judging the significance of acute renal insufficiency, one cannot ignore the fact that the rate of acute renal insufficiency emerging due to medical interventions is rising. The wide-spread diagnostic processes, the interventions and the medicines also promote the emergence of acute renal insufficiency. As for prevention, it is a key task to recognize the high-risk population, assess the renal function and utilize the nephroprotective facilities.
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Affiliation(s)
- János Szegedi
- I. Belgyógyászati Osztály, B. Braun Avitum Hungary Zrt. 2. sz. Dializis Központ, Nyiregyháza.
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47
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Lameire N, Van Biesen W, Vanholder R. The changing epidemiology of acute renal failure. ACTA ACUST UNITED AC 2006; 2:364-77. [PMID: 16932465 DOI: 10.1038/ncpneph0218] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 01/27/2006] [Indexed: 12/13/2022]
Abstract
Different definitions of acute renal failure (ARF) abound. The existence of multiple definitions makes it difficult to determine the true epidemiological characteristics of this condition. Despite this difficulty, it has been possible to detect notable variations in the epidemiology of ARF during the past few decades. The absolute incidence of ARF has increased, while associated mortality rate has remained relatively static. Several factors have contributed to this altered epidemiology. Here, we discuss the relative contribution of these factors, which include site of disease onset (developed or developing countries, community or hospital or intensive care unit), patient age, infections (HIV, malaria, leptospirosis and hantavirus), concomitant illnesses (cardiopulmonary failure, hemato-oncological disease), and interventions (hematopoietic progenitor cell and solid organ transplantation).
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Mataloun SE, Machado FR, Senna APR, Guimarães HP, Amaral JLG. Incidence, risk factors and prognostic factors of acute renal failure in patients admitted to an intensive care unit. Braz J Med Biol Res 2006; 39:1339-47. [PMID: 16906322 DOI: 10.1590/s0100-879x2006001000010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 06/05/2006] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study was to assess the incidence, risk factors and outcome of patients who develop acute renal failure (ARF) in intensive care units. In this prospective observational study, 221 patients with a 48-h minimum stay, 18-year-old minimum age and absence of overt acute or chronic renal failure were included. Exclusion criteria were organ donors and renal transplantation patients. ARF was defined as a creatinine level above 1.5 mg/dL. Statistics were performed using Pearsons' chi2 test, Student t-test, and Wilcoxon test. Multivariate analysis was run using all variables with P < 0.1 in the univariate analysis. ARF developed in 19.0% of the patients, with 76.19% resulting in death. Main risk factors (univariate analysis) were: higher intra-operative hydration and bleeding, higher death risk by APACHE II score, logist organ dysfunction system on the first day, mechanical ventilation, shock due to systemic inflammatory response syndrome (SIRS)/sepsis, noradrenaline use, and plasma creatinine and urea levels on admission. Heart rate on admission (OR = 1.023 (1.002-1.044)), male gender (OR = 4.275 (1.340-13642)), shock due to SIRS/sepsis (OR = 8.590 (2.710-27.229)), higher intra-operative hydration (OR = 1.002 (1.000-1004)), and plasma urea on admission (OR = 1.012 (0.980-1044)) remained significant (multivariate analysis). The mortality risk factors (univariate analysis) were shock due to SIRS/sepsis, mechanical ventilation, blood stream infection, potassium and bicarbonate levels. Only potassium levels remained significant (P = 0.037). In conclusion, ARF has a high incidence, morbidity and mortality when it occurs in intensive care unit. There is a very close association with hemodynamic status and multiple organ dysfunction.
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Affiliation(s)
- S E Mataloun
- Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 04024-900 São Paulo, SP, Brazil
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Wang Y, Cui Z, Fan M. Retrospective analysis on Chinese patients diagnosed with acute renal failure hospitalized during the last decade (1994-2003). Am J Nephrol 2005; 25:514-9. [PMID: 16179778 DOI: 10.1159/000088460] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 08/03/2005] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To investigate the epidemiology, diagnosis and prognosis of acute renal failure (ARF) in hospitalized Chinese during the last decade. METHODS The diagnosis of patients with ARF in Peking University Third Hospital from January 1994 to December 2003 was reconfirmed and the data of epidemiology, etiology and prognosis were analyzed. RESULTS Only 209 discharged cases were diagnosed with ARF and all were reconfirmed. Two peak occurrences were found at ages of 35-45 and 60-80 with a male predominance of approximately 59.7%. Patients diagnosed with ARF accounted for 1.19 per thousand of the admissions in the same period and increased significantly in the last 5 years (p = 0.038). The creatinine level at diagnosis was 345.8 +/- 122.6 micromol/l and had no significant change (p > 0.05). The percent of hospital-acquired ARF (HA-ARF) demonstrated a significant increase in 1999-2003 compared to 1994-1998 (p = 0.008). Intrarenal ARF accounted for 73.69% and was multifactorial, with drugs, infections and operations as leading causes. Renal biopsy was performed in 37.32% (78/209) with 53.84% (42/78) having acute interstitial nephritis. Maintenance dialysis was discontinued in 46.41% because their renal function completely or partially recovered. The overall mortality was 37.91% without improvement over time. The mortality was 6.25% for patients in nephrology department, but 65.51% in ICU (p < 0.001), and was 21.6% for patients in community-acquired ARF (CA-ARF), but 63.1% in HA-ARF (p < 0.001). CONCLUSIONS During the past 10 years, the number of patients diagnosed with ARF has been rising in hospitalized Chinese. HA-ARF was the major source, and infections, drugs and operations were the leading causes. The diagnosis and prognosis of acute renal failure did not improve much in this population over the decade studied.
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Affiliation(s)
- Yue Wang
- Department of Nephrology, Peking University Third Hospital, Beijing 100083, PR China.
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Ympa YP, Sakr Y, Reinhart K, Vincent JL. Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med 2005; 118:827-32. [PMID: 16084171 DOI: 10.1016/j.amjmed.2005.01.069] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Revised: 12/28/2004] [Accepted: 01/04/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine mortality rates in patients with acute renal failure during the past decades. METHODS We performed a MEDLINE search using the keywords "acute renal failure" crossed with "outcome," "mortality," "ICU," "critically ill" or "prognosis" in the period from January 1970 to December 2004. Abstracts and full articles were eligible if mortality rates were reported. We also reviewed the bibliographies of available studies for further potentially eligible studies. The dates of the observation period for each study and not the publication dates were considered for the analysis, so the earliest data were from 1956. RESULTS Of 85 articles fulfilling the criteria, 5 were excluded because of duplicate publications using the same database, so that 80 were included in our review with a total of 15897 patients. Mortality rates in most studies exceeded 30%, and there was no consistent change over time. CONCLUSION Despite technical progress in the management of acute renal failure over the last 50 years, mortality rates seem to have remained unchanged at around 50%.
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Affiliation(s)
- Yvonne Patricia Ympa
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium
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