Recovery of Kidney Function After Acute Kidney Injury in the Elderly: A Systematic Review and Meta-analysis

Schmitt, Roland; Coca, Steven G.; Kanbay, Mehmet; Tinetti, Mary E.; Cantley, Lloyd G.; Parikh, Chirag R.

doi:10.1053/j.ajkd.2008.03.005

Cited by 294 publications

(206 citation statements)

References 39 publications

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“…Conditions that allow for rapid recovery of renal medullary blood flow and quick regained renal function subsequently based on the age and renal volume. 12,26 Previous publications separated AKI duration into several groups including transient azotemia (53 days) and acute tubular necrosis (44 days); short ( 2 days), medium (3-6 days) and long (!7 days); the 1st, 2nd and 3rd tertiles of AKI duration and a renal replacement therapy group. 12,13,27 However, we must be aware of potential bias or confounding in our study because the initiation of renal replacement therapy may fail to control the internal validity of AKI duration, and patients with AKI undergoing renal replacement therapy are excluded.…”

Section: Discussionmentioning

confidence: 99%

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Wang

Chen

et al. 2015

Renal Failure

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(2015) The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study, Renal Failure, 37:6,[985][986][987][988][989][990][991][992][993] CLINICAL STUDYThe association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study Objectives: The severity of acute kidney injury (AKI) has been a well-known predictor for inhospital mortality. Whether AKI duration could predict in-hospital mortality is not clear. This study determines the association between the in-hospital mortality and AKI duration in patients after non-cardiac surgery. Materials and methods: Surgical patients who were admitted to the ICU were enrolled. AKI cases were defined using KDIGO guidelines and categorized according to the tertiles of AKI duration (1st tertile: 2 days, 2nd tertile: 3-6 days and 3rd tertile: 7 days). The adjusted hazard ratios (HRs) for in-hospital mortality are compared to those without AKI. The predictability of mortality is accessed by calculating the area under the curve (AUC) for the receiver operating characteristic (ROC) curve. Results: From a total of 318 postoperative patients, 98 developed AKI (1st tertile: 34 cases, 2nd tertile: 30 cases and 3rd tertile: 34 cases) and 220 had no AKI. The in-hospital mortality rates are 6.8% (non-AKI), 50% (1st tertile), 46.7% (2nd tertile) and 47% (3rd tertile). The HR's for in-hospital mortality are 7.92, 6.68 and 1.68, compared to the non-AKI group (p ¼ 0.006, 0.021 and 0.476). Cumulative in-hospital survival rates are significantly different for the non-AKI group and the AKI groups (p50.001). The AUC for AKI duration and stage together (0.804) is higher than that for AKI stage and AKI duration alone (0.803 and 0.777) (both ps50.001). Conclusion: In addition to severity, the duration of AKI may be a predictor of in-hospital mortality in patients, after non-cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Wang

Chen

et al. 2015

Renal Failure

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“…The increased incidence of AKI in the elderly is thought to be multifactorial, and it is attributable in part to anatomic and physiologic changes in the aging kidney, to an increased burden of comorbidities (hypertension, diabetes mellitus) affecting kidney function, to more frequent exposure to medications and interventions that alter renal hemodynamics or are nephrotoxic, and to alterations in drug metabolism and clearance associated with aging. [9,10] Taken together, the loss of renal functional reserve in the elderly is considered an increased risk for the development of AKI. [11] T h e p r e s e n c e o f b a s e l i n e p r o t e i n u r i a i s a n independent risk factor for AKI.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

Zhang

et al. 2012

World Journal of Emergency Medicine

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BACKGROUND: Acute kidney injury following percutaneous coronary intervention (PCI) is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury (AKI) in patients after intracoronary stent implantation are still unknown. METHODS:A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included: 1) pre-operative ones: age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate (eGFR), hyperuricemia, proteinuria, emergency operation, hydration, medications (ACEI/ARBs, statins); 2) intraoperative ones: dose of contrast media, operative time, hypotension; and 3) postoperative one: hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis. RESULTS:Of the 325 patients, 51(15.7%) developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters (left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular fi ltration rate, hyperuricemia, proteinuria, hydration), emergency operation, intraoperative parameters (operative time, hypotension) and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age (OR=0.253, 95%CI=0.088-0.727), pre-operative proteinuria (OR=5.351, 95%CI=2.128-13.459), pre-operative left ventricular insufficiency (OR=8.704, 95%CI=3.170-23.898), eGFR≤60 ml/min/1.73 m 2 (OR=6.677, 95%CI=1. 167-38.193), prolonged operative time, intraoperative hypotension (OR=25.245, 95%CI=1.001-1.034) were independent risk factors of AKI.CONCLUSIONS: AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the signifi cant risk factors of AKI.

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“…hospitalized). 65,66 Sepsis, nephrotoxic drugs, hypoperfusion, and obstructive uropathy are among the most frequently observed contributing factors. The data as to whether age per se is a risk factor for nonrecovery remain somewhat controversial.…”

Section: Patient-specific Factorsmentioning

confidence: 99%

“…The data as to whether age per se is a risk factor for nonrecovery remain somewhat controversial. Schmitt et al 66 found that, in a meta-analysis of patients with AKI receiving intermittent RRT, the risk of nonrecovery was 50% greater in elderly patients than younger patients. Contrary to that, Schiffl and Fischer 61 showed that, in a cohort of 425 patients in the ICU with AKI, patients with complete or partial recovery did not differ significantly in their mean age.…”

Section: Patient-specific Factorsmentioning

confidence: 99%

Targeting Endogenous Repair Pathways after AKI

Humphreys

Cantaluppi

Portilla

et al. 2016

Journal of the American Society of Nephrology

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AKI remains a highly prevalent disease associated with poor short-and long-term outcomes and high costs. Although significant advances in our understanding of repair after AKI have been made over the last 5 years, this knowledge has not yet been translated into new AKI therapies. A consensus conference held by the Acute Dialysis Quality Initiative was convened in April of 2014 and reviewed new evidence on successful kidney repair to identify the most promising pathways that could be translated into new treatments. In this paper, we provide a summary of current knowledge regarding successful kidney repair and offer a framework for conceptualizing the therapeutic targeting that may facilitate this process. We outline gaps in knowledge and suggest a research agenda to more efficiently bring new discoveries regarding repair after AKI to the clinic.

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Recovery of Kidney Function After Acute Kidney Injury in the Elderly: A Systematic Review and Meta-analysis

Cited by 294 publications

References 39 publications

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

Targeting Endogenous Repair Pathways after AKI

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