Predictors of mortality in elderly patients with acute renal failure in a developing country

Abstract

This prospective study was undertaken to systematically analyze the predictors of mortality in the elderly in a developing country. All elderly patients with ARF hospitalized at this tertiary care centre over 1 year were studied. Various predictors analyzed were hospital-acquired ARF, causative factors of ARF, preexisting hypertension and diabetes mellitus, severity of renal failure (initial and peak serum creatinine, need for dialysis), and complications of ARF: infection during the course of illness; serum albumin levels and critical illness defined as presence of two or more organ system failures excluding renal failure. Of 33,301 patients admitted, 4,255 (12.7%) were elderly. Of these 69 (1.6%) had ARF. On analysis of the whole group, both young and elderly, age >60 years had an independent predictor of mortality (odds ratio 5.6, P = 0.001). Forty-two of the 69 (60.9%) elderly ARF patients died. The mortality was significantly increased in those elderly with hospital-acquired ARF (79.2%, P = 0.027), those with sepsis as a cause of ARF (71.2%, P = 0.004), those who required dialysis (72.5%, P = 0.022), those developing an infection during the course of ARF (87.9%, P = 0.000) and in those with a critical illness (90.0%, P = 0.00). On logistic regression analysis of those variables that were significant on univariate analysis, only critical illness (odds ratio 9.97) and infection during course (odds ratio 9.72) were the independent predictors of mortality. To conclude, ARF complicates only 1.6% of hospitalized elderly patients but is associated with a high mortality rate of 61%. Infection during the course of illness and critical illness were the independent predictors of mortality.

NGAL: a biomarker of acute kidney injury and other systemic conditions

“…However, morbidity and mortality have not improved significantly [31][32][33]. Serum creatinine is an insensitive and late marker [34] for AKI.…”

Acute kidney injury in the elderly population

“…However, the average age of CA-AKI patients was younger, and the age gap between the survivor group and nonsurvivor group of CA-AKI was larger. These findings suggested that older patients with CA-AKI or HA-AKI were more susceptible to death and that age might be an important determinant of long-term outcome [1,[17][18][19].…”

“…Several risk models exist for predicting the prognosis in critically ill patients with AKI, especially in situations where AKI occurs as part of a multiple system organ failure. Until a validated method of assessing prognosis and predicting the outcome in the individual patient with AKI is available, most studies continue to show only general associations between reduced survival and various risk factors (including older age, greater burden of co-morbidity, chronic liver disease, higher severity of illness, severe sepsis/ septic shock, and post-cardiac surgical AKI) [74][75][76][77][78][79]. Recent data suggest that in critically ill patients with severe AKI, an RRT requirement independently predicted death [80].…”

“…Santacruz et al [78] found that the global mortality of elderly patients with AKI in intensive care units was 53%. Recent studies showed that the mortality of AKI in elderly patients was higher compared to that in younger population [74][75][76][77][78][79][80][81][82][83]. Chronic diseases in combination with age, sex, and activity of daily living (ADL) performance provide important prognostic information concerning mortality risk in elderly patients.…”

Epidemiology, outcomes and validation of RIFLE and AKIN criteria in acute kidney injury (AKI) in critically ill patients: Indian perspective

“…Very few studies have attempted to explore the epidemiology of AKI in India. [15][16][17][18][19][20] However, these studies have either evaluated specific patient population or included patients outside the ICU, pediatric patients or have not used RIFLE or AKIN criteria to define, stratify or prognosticate AKI. Hence, in this study we aim to explore the epidemiology of AKI using both the RIFLE and AKIN criteria and to determine the prognostic validity of these criteria in an Indian ICU.…”