Outcome in a post-cardiac surgery population with acute renal failure requiring dialysis: does age make a difference?

Noortgate, Nele Van Den; Mouton, Veerle; Lamot, C.; Nooten, Guido Van; Dhondt, Annemieke; Vanholder, Raymond; Afschrift, Marcel; Lameire, Norbert

doi:10.1093/ndt/gfg043

Cited by 55 publications

(35 citation statements)

References 18 publications

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“…While Chertow et al [7] demonstrated an evident relationship between the increase in age and the incidence of dialytic ARF, Van den Noortgate et al [19] did not find any significant difference in patients with ages equal to or greater than 70 years old, when compared to under 70-yearolds, in a retrospective study of 3736 adults. The current work did not show any relationship between ARF and age.…”

Section: Discussionmentioning

confidence: 92%

“…Several authors utilize the term "renal dysfunction" for non-dialytic ARF, defining it as the presence of serum creatinine increases of around 25 to 50% of the preoperative value and the term "renal failure" for patients with dialytic ARF [5][6][7][8][9]18,19]. Although it seems more objective, the definition of ARF based on dialysis also depends on the experience of the nephrology team, although defined classical criteria are followed.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fatores de risco pré-operatórios para o desenvolvimento de Insuficiência Renal Aguda em cirurgia cardíaca

Kochi¹,

Martins²,

Balbi³

et al. 2007

Rev Bras Cir Cardiovasc

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Fatores de risco pré-operatórios para o desenvolvimento de Insuficiência Renal Aguda em cirurgia cardíaca

Kochi¹,

Martins²,

Balbi³

et al. 2007

Rev Bras Cir Cardiovasc

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“…[1][2][3][4][5][6]8,10,11,14,16 Critical to prevention and therapy is identification of risk factors. Previous risk profiles were limited to single-center experi- ences with site-specific data fields and hence restricted generalization, small sample size without a validation cohort, and incomplete characterizations of patients.…”

Section: Discussion General Overview: Summarymentioning

confidence: 99%

“…42,43 Age, although a direct marker for underlying degenerative disease in many specific organ systems, has not always been identified as an independent predictor of renal dysfunction risk after cardiac surgery. 1,2,4,10,16 We have shown that arterial stiffening manifested by increased PP is an independent variable that portends increased perioperative renal dysfunction outcome and may be more discriminating than age per se. In another study, 48 ascending aorta atherosclerosis predicted postoperative renal dysfunction, with advanced age directly associated with atherosclerotic severity.…”

Section: Pp Hypertensionmentioning

confidence: 97%

Risk Index for Perioperative Renal Dysfunction/Failure

et al. 2007

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Background— An acute renal event after coronary bypass graft surgery is associated with high mortality and substantial additive cost. Methods and Results— This prospective and descriptive study of 4801 patients having coronary bypass graft surgery with cardiopulmonary bypass from November 1996 to June 2000 at 70 centers in 16 countries established associations between predictor variables and postoperative renal composite (renal dysfunction and/or renal failure) from a cohort of 2381 patients and developed a risk index assessed in a validation cohort of 2420 patients. Postoperative renal composite occurred in 231 patients (4.8%). Independent and significant risk factors were age >75 years (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.23 to 3.37; P =0.006), preoperative congestive heart failure (OR, 2.38; CI, 1.55 to 3.64; P <0.001), prior myocardial infarction (OR, 1.75; CI, 1.08 to 2.83; P =0.023), preexisting renal disease (OR, 3.71; CI, 2.41 to 5.70; P <0.001), intraoperative multiple inotrope use (OR, 2.75; CI, 1.75 to 4.31; P <0.001), intraoperative intra-aortic balloon pump insertion (OR, 4.41; CI, 2.21 to 8.80; P <0.001), cardiopulmonary bypass >2 hours (OR, 1.78; CI, 1.15 to 2.74; P =0.01), and preoperative pulse pressure such that for every additional 20–mm Hg increment in pulse pressure >40 mm Hg, there was an OR of 1.49 (CI, 1.17 to 1.89; P =0.001). Patients with pulse pressure hypertension >80 mm Hg were 3 times more likely to die a renal-related death compared with those without (3.7% versus 1.1%). Conclusions— Beside established risk factors, pulse pressure is independently and significantly associated with increased renal composite.

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“…The numbers of patients ages.60 years in Western Europe and the United States are projected to rise from 231 million in 2000 to 395 million in 2050 (2). The incidence of AKI in the elderly varies according to the population studied, but multiple studies have shown that the elderly are more susceptible to the development of AKI than younger patients (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

The Ethics of Offering Dialysis for AKI to the Older Patient

Akbar

Moss

2014

Clinical Journal of the American Society of Nephrology

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Older patients are more susceptible to AKI. In the elderly, AKI has been associated with increased morbidity and mortality, and it is a significant risk factor for CKD and dialysis-dependent ESRD. There are now accumulating data that the start of dialysis for some older patients is associated with poor outcomes, such as high treatment intensity, suffering, and limited life prolongation, which occur at the expense of dignity and quality of life. The biomedicalization of aging is a relatively recent field of ethical inquiry with two directly relevant features to decisions about starting dialysis for older patients with AKI: (1) the routinization of geriatric clinical interventions, such as dialysis, which results in the overshadowing of patient choice, and (2) the transformation of the technological imperative into the moral imperative. A major consequence of the biomedicalization of aging is that societal expectations about standard medical care have resulted in the relatively unquestioned provision of dialysis for AKI to older patients. This paper calls for nephrologists to re-examine the data and their attitudes to offering dialysis to older patients with AKI, especially those patients with underlying CKD and significant comorbidities. Shared decisionmaking and the reinforcement of the right of the patient to make a choice need to slow down the otherwise ineluctable routinization of starting old and very sick patients on dialysis. In the process of shared decision-making, nephrologists should not automatically recommend dialysis for older patients; in those patients who can be predicted to do poorly, recommending against dialysis upholds the Hippocratic maxim to be of benefit and do no harm. This paper challenges the automatic transformation of the technological imperative into the moral imperative for older patients with AKI and points to the need for a re-evaluation of dialysis ethics in this population.

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Outcome in a post-cardiac surgery population with acute renal failure requiring dialysis: does age make a difference?

Cited by 55 publications

References 18 publications

Fatores de risco pré-operatórios para o desenvolvimento de Insuficiência Renal Aguda em cirurgia cardíaca

Fatores de risco pré-operatórios para o desenvolvimento de Insuficiência Renal Aguda em cirurgia cardíaca

Risk Index for Perioperative Renal Dysfunction/Failure

The Ethics of Offering Dialysis for AKI to the Older Patient

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