Acute Kidney Injury and Chronic Kidney Disease in the Elderly and Polypharmacy

Abstract

Background: Acute kidney injury (AKI) incidence is reported to be 10 times higher in aged people. Related to their higher prevalence of chronic kidney disease (CKD), older patients are at high risk of toxic effects driven by drugs. Methods: The demographics, hospitalizations, visits to the Emergency Department, pharmacological therapy, and lab tests were analyzed in 71,588 individuals. Results: Data showed a higher prevalence of AKI as well as CKD in the elderly as compared to the younger group, with an associated very high mortality. A broad number of drugs was prescribed, ranging from 1 to 35, the majority being between 5 and 9 drugs. Conclusion: Elderly patients who developed AKI had a higher number of hospitalizations (underlying frailty), were more likely to progress to more severe stages of CKD and to be affected by other non-renal pathologies (associated comorbidities) and to be given heavier pharmacological prescriptions (polypharmacy).

Chronic Kidney Disease Management in General Practice: A Focus on Inappropriate Drugs Prescriptions

“…The elderly have a higher prevalence of risk factors related to the onset and the progression of CKD [31]. Furthermore, older people daily take a broad number of drugs, thus increasing the probability of inappropriate prescriptions [32,33]. Multimorbidity was very common in patients with CKD and the number of comorbidities was linked with a faster decline of the renal function [34].…”

“…An increased number of prescriptions was found with an increased stage of CKD (G3a-G5): G3a: 113 (60-187); G3b: 152 (91-229); G4/G5: 196 (117-65), as well as the number of different active substances prescribed: G3a: 18 (12-25); G3b: 22 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29); G4/G5: 25 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The frequency of comorbidities stratified by the severity of CKD are shown in Supplementary Table S2.…”

Molecular Mechanisms of AKI in the Elderly: From Animal Models to Therapeutic Intervention

“…Diabetes mellitus is present in almost 20-30% of the elderly population in Western countries [44]; the high-glucose concentration damages blood vessels (microvascular damage) also in the glomerular structure, leading to several toxic effects and consequent micro-infarcts with reduced renal functional reserve. The persistence of hyperglycemia induces the formation of advanced glycation end-products (AGE), which lead to increased production of extracellular matrix, occlusion of the glomerular capillaries and cellular damage [23,42].…”

“…Recently, in a comprehensive study of a national pharmacovigilance database, gentamicin emerged as the main drug class that frequently induced AKI [54]. Aminoglycosides and amphotericin B are well recognized nephrotoxic agents in the elderly, and the estimation of appropriate dosing by careful evaluation of creatinine and body mass is a crucial issue for clinicians [23].…”

“…Other comorbidities such as diabetes mellitus, hypertension and hearth failure (HF), frequently affecting elderly patients, could act as additional risk factors for AKI establishment. Moreover, older patients are exposed to multiple potentially nephrotoxic medications and invasive procedures [22,23]. The elderly exhibit, in absence of other specific comorbidities, a process of physiological, structural and functional involvement, named "kidney aging", which represents a further risk factor for AKI [24].…”