Mortality in the elderly with acute kidney injury in an internal medicine department in Abidjan, Cote D'Ivoire

Abstract

Acute kidney injury (AKI) in the elderly is characterized by high mortality. The objective of this study is to identify the causes of death in the elderly with AKI. This is a prospective cohort study with a descriptive purpose which was carried out during the period from January 2009 to December 2014 in the Department of Nephrology-Internal Medicine of Treichville University Hospital. The diagnosis of AKI was made on the basis of serum creatinine (SCr) values determined during hospitalization, according to KDIGO classification. Our study involved 107 elderly aged 65 and older with AKI. The hospital mortality rate was 46.7% (50/107). The average age of deceased patients was 71.8 ± 7 years with extremes of 65 and 90 years. We observed a male predominance with a sex ratio (41/9) of 4.55. AKI on admission was in Stage 1 in 16% of cases, in Stage 2 in 24%, and in Stage 3 in 60% cases. SCr was normal in 8%, the AKI was in Stage 1 in 34% (P = 0.09), Stage 2 in 18% (P = 0.001), and Stage 3 in 40% (P = 0.0001). AKI in deceased patients was organic in 36% of cases, obstructive in 30%, and functional in 6%. The etiologies of AKI were infections (46%), cancer (18%), benign tumors of the urinary tract (12%), malignant hypertension (6%), decompensated heart disease (6%), and drugs (6%). The main causes of death were sepsis (28%), cardiovascular disease (22%), severe renal failure (20%), pelvic cancers (16%), and liver failure (12%). All patients with cancer (P = 0.001) or HIV infected (P = 0.009) died. Sixty-eight percent of deaths occurred the 1 week. Death was earlier by sepsis and cardiovascular disease than by cancer. Mortality is high in the elderly. The main causes of death were sepsis, cardiovascular disease, renal failure, pelvic cancer, and liver failure.

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

“…Patients who develop AKI may recover completely or partially the renal function or may evolve to CKD requiring dialysis or even AKI-related death depending on several factors (comorbidities, sepsis, etc.) [9,167,168].…”

“…Acute kidney injury (AKI) is one of the most serious complications of hospitalized patients, mainly in Intensive Care Unit (ICU) [1][2][3][4], still associated to unacceptable high mortality and morbidity [5][6][7]. Patients who develop AKI during hospitalization show mortality rates of about 50% that exceed 80% if renal replacement therapy (RRT) is needed [8,9].…”

Acute kidney injury in elderly patients: narrative review on incidence, risk factors, and mortality

“…Despite all therapeutic advances in the past decades, the overall mortality of patients with AKI remains around 50% and can reach up to 80% in critically ill patients, [4][5][6] depending on clinical conditions, comorbidities, and the need for renal replacement therapy. [4][5][6][7] Although AKI is a frequent disorder associated with high mortality, only recently was there a consensus on its definition: in 2012 a new definition and staging criteria of AKI, covering both Acute Kidney Injury Network and Risk, Injury, Failure, Loss and End Stage criteria, was proposed by Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. Therefore, AKI is now defined as an increase in serum creatinine (SCr) ≥0.3 mg/dL in 48 hours or an increase up to 1.5 times the SCr baseline within 7 days or a urine output <0.5 mL/kg/hour for more than 6 hours.…”

Early diagnosis and prevention of acute kidney injury in elderly patients after urgent abdominal surgery

“…Загальна смертність пацієнтів з гострою нирковою недостатністю залишається близько 50 % і може досягати 80 % у хворих в критичному стані залежно від клінічних умов, супутніх захворювань [11][12][13][14][15][16][17]. S.G. Coca та співавт.…”