Comparative study of community acute kidney injury in young patients versus elderly patients in an internal medicine department in Abidjan (Côte d’Ivoire)

Abstract

IntroductionAcute kidney injury (AKI) is characterized by a sudden drop in glomerular filtration rate. It is commonly seen in our medical practice. Its incidence varies from 1.9% to 24.4% depending on the series (1-4). In intensive care units, this incidence is in the order of 20% to 50% (5). The etiologies of AKI vary from one region to the other of the world. In the West countries, septic shock, hyopovolemia, cardiogenic shock and post-operative AKI are the most common in adults (4). In Africa, the Implication for health policy/practice/research/medical education:In our study, we found that regardless of age, infection is the leading cause of acute kidney injury (AKI). Drug-induced AKI is more common in young adults. On the other hand, benign tumor of the urinary tract and malignant hypertension are more found in the elderly. In addition, mortality and non-recovery of renal function are higher in the elderly. The causes of death and the factors associated with mortality and non recovery of renal function differ in both groups. Please cite this paper as: Introduction:Numerous studies have shown that the recovery of renal function was slower and less complete in the elderly patients than in adults. Objectives: To compare the profile of acute kidney injury (AKI) of the young patients with that of the elderly patients. Patients and Methods: This is a prospective study carried out during the period from January 2010 to December 2015 in the department of Nephrology-Internal Medicine of the University hospital of Treichville. The diagnosis of AKI was retained according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: The mean age of patients was 26.8 ± 6 years in the young and 69.4 ± 7 years in the elderly. The proportion of males was 51.9% (55/106) in the young patients against 77.8% (84/108) in the elderly patients (P = 0.0001). The proportion of hypertension and diabetes in the elderly patients, respectively 30.6% and 36.1% was statistically higher than in the young patients (P = 0.001). However, human immunodeficiency virus (HIV) infection was more prevalent in the young patients (P = 0.0001). Anemia was observed in 84.9% in the young patients against 58.3% in the elderly patients (P = 0.001). It was severe in 34% among the young patients against 15.7% among the elderly patients (P = 0.002). The proportion of drug AKI was 17% in the young patients against 2.8% in the elderly patients (P = 0.0001). Malignant hypertension (P = 0.002) and urinary tract tumors (P = 0.001) were more observed in the elderly patients. Mortality was 31.1% in the young patients against 47.2% in the elderly patients (P = 0.011). Conclusion:The etiologies are the same with different proportions, except malignant hypertension observed only in the elderly patients. Mortality is higher in the elderly patients.

Acute kidney injury in HIV‐infected patients: a critical review

“…The severity of acute illness as quantified by the SAPS II or APACHE II scores has also been associated with AKI in studies by Lopes et al and Randall et al [35,36]. The presence of sepsis is also a predictor of AKI in HIVinfected patients [25,26,29].…”

“…The reported incidence of AKI in HIV-infected patients is also variable depending on the setting. Although the majority of studies are retrospective, with different patient characteristics and follow-up times, the lowest incidence rate of AKI is reported in ambulatory patients, ranging from 5.7 to 9.4% [22][23][24] and up to 35% in developing countries [25], followed by hospitalized patients [8,[26][27][28][29][30][31][32][33][34] and the highest among critically ill patients, reaching up to 66% [35,36] (Table 2).…”

“…Several studies have reported associations between AKI and advanced age, male gender, diabetes, hypertension and pre-existing CKD [8,[24][25][26]34]. Also, hepatitis C virus (HCV) coinfection, low serum albumin (< 3.7 mg/dL), low body mass index (< 18.5 kg/m 2 ), black race, cardiovascular disease, chronic hepatic disease and hypomagnesaemia have been reported as predictors of AKI and outcomes [8,23,28,33,[40][41][42][43][44][45].…”