Acute Kidney Injury and In-Hospital Mortality: A Retrospective Analysis of a Nationwide Administrative Database of Elderly Subjects in Italy

Abstract

Background: The aim of this study was to investigate the association between acute kidney injury (AKI) and in-hospital mortality (IHM) in a large nationwide cohort of elderly subjects in Italy. Methods: We analyzed the hospitalization data of all patients aged ≥65 years, who were discharged with a diagnosis of AKI, which was identified by the presence of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and extracted from the Italian Health Ministry database (January 2000 to December 2015). Data regarding age, gender, dialysis treatment, and comorbidity, including the development of sepsis, were also collected. Results: We evaluated 760,664 hospitalizations, the mean age was 80.5 ± 7.8 years, males represented 52.2% of the population, and 9% underwent dialysis treatment. IHM was 27.7% (210,661 admissions): Deceased patients were more likely to be older, undergoing dialysis treatment, and to be sicker than the survivors. The population was classified on the basis of tertiles of comorbidity score (the first group 7.48 ± 1.99, the second 13.67 ± 2,04, and third 22.12 ± 4.13). IHM was higher in the third tertile, whilst dialysis-dependent AKI was highest in the first. Dialysis-dependent AKI was associated with an odds ratios (OR) of 2.721; 95% confidence interval (CI) 2.676–2.766; p < 0.001, development of sepsis was associated with an OR of 1.990; 95% CI 1.948–2.033; p < 0.001, the second tertile of comorbidity was associated with an OR of 1.750; 95% CI 1.726–1.774; p < 0.001, and the third tertile of comorbidity was associated with an OR of 2.522; 95% CI 2.486–2.559; p < 0.001. Conclusions: In elderly subjects with AKI discharge codes, IHM is a frequent complication affecting more than a quarter of the investigated population. The increasing burden of comorbidity, dialysis-dependent AKI, and sepsis are the major risk factors.

Weekend Effect and in-Hospital Mortality in Elderly Patients with Acute Kidney Injury: A Retrospective Analysis of a National Hospital Database in Italy

“…Last year, our group demonstrated that in-hospital mortality was a frequent complication in elderly subjects with AKI discharge codes, involving more than a quarter of admissions. The increasing burden of comorbidity, dialysis-dependent AKI, and sepsis were the major risk factors for mortality [ 16 ]. Comorbidity is a well-known risk factor affecting survival in dialysis patients [ 44 ]; however, predictors of short-term survival in renal patients are still a matter of debate.…”

“…Therefore, the debate about clinical impact of the WE effect is still open. Acute kidney injury (AKI) is a frequent finding in hospitalized subjects, especially in people who are 65 years old or older [ 15 , 16 , 17 ]. However, available data about admissions due to renal diseases are scarce; therefore, we wanted to explore the possible relationship between the WE effect and AK by using the National Hospital Database (NHD).…”

Clinical Profile and Outcome of Acute Kidney Injury in Elderly Adults in a Tertiary Hospital in Cameroon

“…Nephrotoxic AKI was observed in 14.5% of the elderly and was mainly due to use of aminoglycoside and herbal remedies. Nephrotoxicity is linked to 10% -20% of AKI in Cameroonian studies [14] [15] [23]. However, Yao et al, found a lower frequency of nephrotoxic AKI in the elderly (2.8% vs 17%) compared to young adults [11].…”

“…[13] [14] comorbid burden was high in our F. M. E. E. H. Danielle et al DOI: 10.4236/ojneph.2020.104031 319 Open Journal of Nephrology population, especially among very elderly patients. As noted in our study, hypertension, diabetes and cardiac disease were the main comorbidities reported [11] [14] [15] [16] [17] [18] and are all associated with renal vasculature damage and compromised renal perfusion.…”

Kidney problems in disaster situations

“…Officially, 17,000 people were killed but very likely the death toll was higher. In total 639 cases of AKI were registered of whom 477 needed dialysis, with a mortality of AE15% [49,50], a low figure compared to standard non-earthquake AKI practice [51]. The experience gained during the earthquake led the foundation for an extensive epidemiological analysis, which was highly helpful to increase objective datadriven knowledge on post-earthquake crush syndrome and AKI.…”