Clinical features, risk factors, and clinical burden of acute kidney injury in older adults

Wu, Yanhua; Hao, Wenke; Chen, Yuanhan; Chen, Shaohua; Liu, Wei; Yu, Feng; Hu, Weixian; Liang, Xinling

doi:10.1080/0886022x.2020.1843491

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…In our study of community-dwelling adults aged 70 + we found that 19% developed a first incident AKI over a median follow-up time of 8.8 years confirming that AKI is a very common in-hospital complication at old age [ 11 , 22 , 23 ]. In men, the IR of AKI was considerably higher compared to women.…”

Section: Discussionmentioning

confidence: 63%

Incidence of hospital-acquired acute kidney injury and trajectories of glomerular filtration rate in older adults

et al. 2023

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Background In older adults, epidemiological data on incidence rates (IR) of hospital-acquired acute kidney injury (AKI) are scarce. Also, little is known about trajectories of kidney function before hospitalization with AKI. Methods We used data from biennial face-to-face study visits from the prospective Berlin Initiative Study (BIS) including community-dwelling participants aged 70+ with repeat estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C. Primary outcome was first incident of hospital-acquired AKI assessed through linked insurance claims data. In a nested case-control study, kidney function decline prior to hospitalization with and without AKI was investigated using eGFR trajectories estimated with mixed-effects models adjusted for traditional cardiovascular comorbidities. Results Out of 2020 study participants (52.9% women; mean age 80.4 years) without prior AKI, 383 developed a first incident AKI, 1518 were hospitalized without AKI, and 119 were never hospitalized during a median follow-up of 8.8 years. IR per 1000 person years for hospital-acquired AKI was 26.8 (95% confidence interval (CI): 24.1–29.6); higher for men than women (33.9 (29.5–38.7) vs. 21.2 (18.1–24.6)). IR (CI) were lowest for persons aged 70–75 (13.1; 10.0-16.8) and highest for ≥ 90 years (54.6; 40.0-72.9). eGFR trajectories declined more steeply in men and women with AKI compared to men and women without AKI years before hospitalization. These differences in eGFR trajectories remained after adjustment for traditional comorbidities. Conclusion AKI is a frequent in-hospital complication in individuals aged 70 + showing a striking increase of IR with age. eGFR decline was steeper in elderly patients with AKI compared to elderly patients without AKI years prior to hospitalization emphasising the need for long-term kidney function monitoring pre-admission to improve risk stratification.

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Section: Discussionmentioning

confidence: 63%

Incidence of hospital-acquired acute kidney injury and trajectories of glomerular filtration rate in older adults

et al. 2023

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“…In a previous study, we found an overall incidence of AKI in very elderly patients of 14.8% [ 7 ]. Older individuals are more likely to experience AKI, with morbidity increasing with age [ 13 ]. The kidneys of older individuals are affected by structural and functional changes caused by factors such as aging, comorbidities, and multiple medications; therefore, they have a higher incidence of AKI with a poor prognosis and a higher mortality risk than the general population [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Diabetes on the Recurrence and Prognosis of Acute Kidney Injury in Older Male Patients: A 10-Year Retrospective Cohort Study

Shen

Hou

et al. 2022

Diabetes Ther

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Introduction: While patients with diabetes are at higher risk of developing acute kidney injury (AKI), there are few studies on the recurrence of AKI in older adult patients. This study therefore aimed to examine the impact of diabetes on AKI recurrence and long-term outcomes in older male patients. Methods: This retrospective cohort study included older male patients who experienced AKI during hospitalization from July 2007 to August 2011. Medical records of all patients were followed up for 10 years. Patients with AKI Xin Shen and Kunming Lv contributed equally to this work.

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“…There was a tendency for the MAKIPS to overestimate slightly the risk of HA-AKI at category risks ˂0.19 and to underestimate the risk at category risks between 0.22 and 0.67. In both studies, this overestimating and underestimating tendency could be explained by the fact that the risk of developing HA-AKI depends not only on demographic data, chronic comorbidities and surgical procedures, but also on risk factors related to the inflammatory environment, haemodynamic status and exposure to contrast media or nephrotoxic drugs during the hospital stay, among others [ 29–31 ]. This last set of variables involves acute precipitants and may arise throughout the hospitalization period and can lead to relevant changes in the risk profile of patients that cannot be identified with predictive models such as the MAKIPS, which do not include these variables as predictors.…”

Section: Discussionmentioning

confidence: 99%

External validation of the Madrid Acute Kidney Injury Prediction Score

Carpio

Marco

Martín

et al. 2021

Clinical Kidney Journal

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Background The Madrid Acute Kidney Injury Prediction Score (MAKIPS) is a recently described tool able to do an automatic calculation of the risk of hospital-acquired AKI (HA-AKI) from electronic clinical records and could easily be implemented in clinical practice but, to date, it has not been externally validated. The objective of our study was to perform an external validation of the MAKIPS score in a hospital with different characteristics and case-mix. Methods External validation cohort study of the MAKIPS score, performed on patients hospitalized at a single tertiary hospital between April 2018 and September 2019. Performance was assessed by discrimination using area under the receiver operating characteristic curves (AUCROC) and calibration plots. Results HA-AKI in the external validation cohort was 5.3%. When compared to the MAKIPS cohort, the validation cohort showed a higher prevalence of men, diabetes, hypertension, cardiovascular disease, cerebrovascular disease, anaemia, congestive heart failure, chronic pulmonary disease, connective tissue diseases and renal disease, whereas, the prevalences of peptic ulcer disease, liver disease, malignancy, metastatic solid tumours and AIDS were significantly lower. In the validation cohort, the MAKIPS score showed an AUC of 0.798 (95% CI 0.788 -0.809). Calibration plots showed that at probability rates below 0.19, the score tended to overestimate, and at probability rates between 0.22 and 0.67, rates the score tended to underestimate the risk of HA-AKI. Conclusions The MAKIPS score can be a useful tool, easily obtainable from electronic records, to predict HA-AKI in hospitals with different case-mix characteristics.

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Clinical features, risk factors, and clinical burden of acute kidney injury in older adults

Cited by 13 publications

References 34 publications

Incidence of hospital-acquired acute kidney injury and trajectories of glomerular filtration rate in older adults

Incidence of hospital-acquired acute kidney injury and trajectories of glomerular filtration rate in older adults

Impact of Diabetes on the Recurrence and Prognosis of Acute Kidney Injury in Older Male Patients: A 10-Year Retrospective Cohort Study

External validation of the Madrid Acute Kidney Injury Prediction Score

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