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Dias RPL, Duarte DB, Barbosa DDCBM, Campos RP. Acute kidney injury in nonagenarians: clinical characteristics and mortality. J Bras Nefrol 2024; 46:e20230088. [PMID: 38788055 DOI: 10.1590/2175-8239-jbn-2023-0088en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/16/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. METHODS Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. RESULTS A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality. CONCLUSION AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.
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Affiliation(s)
| | - Daniella Bezerra Duarte
- Centro Universitário Tiradentes, Faculdade de Medicina, Maceió, AL, Brazil
- Universidade Federal de Alagoas, Faculdade de Medicina, Maceió, AL, Brazil
- Santa Casa de Misericórdia de Maceió, Instituto de Nefrologia Ribamar Vaz, Maceió, AL, Brazil
| | | | - Rodrigo Peixoto Campos
- Universidade Federal de Alagoas, Faculdade de Medicina, Maceió, AL, Brazil
- Santa Casa de Misericórdia de Maceió, Instituto de Nefrologia Ribamar Vaz, Maceió, AL, Brazil
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Pang Z, Zou W. Advances of perioperative acute kidney injury in elderly patients undergoing non-cardiac surgery. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:760-770. [PMID: 37539579 PMCID: PMC10930413 DOI: 10.11817/j.issn.1672-7347.2023.220629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Indexed: 08/05/2023]
Abstract
The risk of developing perioperative acute kidney injury (AKI) in elderly patients increases with age. The combined involvement of aging kidneys, coexisting multiple underlying chronic diseases, and increased exposure to potential renal stressors and nephrotoxic drugs or invasive procedures constitute susceptibility factors for AKI in elderly patients. The perioperative AKI in elderly patients undergoing noncardiac surgery has its own specific population characteristics, so it is necessary to further explore the characteristics of AKI in elderly patients in terms of epidemiology, clinical diagnosis, risk factors, and preventive and curative measures to provide meaningful clinical advice to improve prognosis, accelerate recovery, and reduce medical burden in elderly patients. Since AKI has the fastest-growing incidence in older patients and is associated with a worse prognosis, early detection, early diagnosis, and prevention of AKI are important for elderly patients in the perioperative period. Large, multicenter, randomized controlled clinical studies in elderly non-cardiac surgery patients with AKI can be conducted in the future, with the aim of providing the evidence to reduce of the incidence of AKI and to improve the prognosis of patients.
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Affiliation(s)
- Zhaohua Pang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China.
| | - Wangyuan Zou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China.
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Prabhudev P, Ramamoorthi K, Acharya RV. A Clinical and Demographic Profile of Elderly (>65 Years) in the Medical Intensive Care Units of a Tertiary Care Center. Indian J Crit Care Med 2023; 27:166-175. [PMID: 36960107 PMCID: PMC10028716 DOI: 10.5005/jp-journals-10071-24416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/29/2023] [Indexed: 03/05/2023] Open
Abstract
Background The elderly population in India is expected to increase to 319 million by 2050. Managing critically ill elderly patients in intensive care units (ICUs) is a difficult task. Proper planning and development of healthcare infrastructure are of prime importance to face this challenge. Objectives To study the clinical profile and outcomes of elderly patients admitted to the medical ICUs. Materials and methods A time-bound, prospective observational study on elderly patients admitted to medical ICUs for more than 48 hours was conducted from March 2019 to September 2020. The demographic, biochemical, hematologic, and microbiological data on antibiotic susceptibility patterns on various organisms and procalcitonin (PCT) reports were collected. Acute Physiology and Chronic Health Evaluation II (APACHE II) score was calculated. Various treatment modalities, such as mechanical ventilation, inotropes, hemodialysis, antibiotics, culture report in sepsis patients, and length of ICU stay were collected. Results The age of the patients and the length of their ICU stay were not significantly associated with outcomes. Sepsis and APACHE II scores are significantly associated with outcomes. Receipt of mechanical ventilation, vasopressor support, and hemodialysis are significantly associated with mortality (p < 0.001). Conclusion The patients' ages were not significantly associated with outcomes. The most common cause of death among elderly patients was found to be sepsis, followed by pneumonia. In elderly ICU patients, gram-negative organisms are the most common causative agents in bloodstream infections. The APACHE II score, sepsis, receipt of mechanical ventilation, vasopressor support, and hemodialysis are significantly associated with mortality. How to cite this article Prabhudev P, Ramamoorthi K, Acharya RV. A Clinical and Demographic Profile of Elderly (>65 Years) in the Medical Intensive Care Units of a Tertiary Care Center. Indian J Crit Care Med 2023;27(3):166-175.
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Affiliation(s)
- Pruthvi Prabhudev
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kusugodlu Ramamoorthi
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Kusugodlu Ramamoorthi, Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, Phone: +91 9449615194, e-mail:
| | - Raviraja V Acharya
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Akinosoglou K, Schinas G, Almyroudi MP, Gogos C, Dimopoulos G. The impact of age on intensive care. Ageing Res Rev 2023; 84:101832. [PMID: 36565961 PMCID: PMC9769029 DOI: 10.1016/j.arr.2022.101832] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Caring for the elderly has always been challenging for the intensive care unit (ICU) physician. Concerns like frailty, comorbidities, polypharmacy and advanced directives come up even before admission into the unit. The COVID-19 pandemic has put forward a variety of issues concerning elderly populations, making the topic more relevant than ever. Admittance to the ICU, an unequivocally multifactorial decision, requires special consideration from the side of the physician when caring for an elderly person. Patients' wishes are to be respected and thus given priority. Triage assessment must also account for age-related physiological alterations and functional status. Once in the ICU, special attention should be given to age-related specificities, such as therapeutic interventions' controversial role, infection susceptibility, and post-operative care, that could potentially alter the course of hospitalization and affect outcomes. Following ICU discharge, ensuring proper rehabilitation for both survivors and their caregivers can improve long-term outcomes and subsequent quality of life. The pandemic and its implications may limit the standard of care for the elderly requiring ICU support. Socioeconomic factors that further perplex the situation must be addressed. Elderly patients currently represent a vast expanding population in ICU. Tailoring safe treatment plans to match patients' wishes, and personalized needs will guide critical care for the elderly from this time forward.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, Medical School University of Patras, Greece.
| | - Georgios Schinas
- Department of Internal Medicine, Medical School University of Patras, Greece
| | - Maria Panagiota Almyroudi
- Department of Emergency Medicine, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Greece
| | - Charalambos Gogos
- Department of Internal Medicine and Infectious Diseases, Medical School University of Patras, Greece
| | - George Dimopoulos
- 3rd Department of Critical Care, EVGENIDIO Hospital, National and Kapodistrian University of Athens, Medical School, Greece
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Molina-Andújar A, Casals J, Del Risco-Zevallos J, Hermida E, Quintana LF, Blasco M, Piñeiro G, Poch E. Acute renal replacement therapy in critically ill octogenarian or older patients: prognostic factors and renal outcomes. J Nephrol 2021; 34:1531-1536. [PMID: 33818745 DOI: 10.1007/s40620-021-01034-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/18/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The number of octogenarians or older patients admitted to the intensive care unit (ICU) has been growing over the past several years. The aim of this study is to assess factors associated with acute renal replacement therapy (ARRT) requirement in these patients and the impact of this therapy on 90-day mortality. We also aimed to identify prognostic factors associated with mortality risk in the group of patients that required ARRT. METHODS Retrospective study of octogenarian or older patients admitted to the ICU at Hospital Clínic de Barcelona from June 2007 to April 2019. Patients on chronic dialysis treatment or with a kidney transplant, and patients with limitation of therapeutic support or admitted for less than 48 h were excluded. RESULTS 217 patients were included in the study, of whom 36.4% required ARRT. Use of vasoactive drugs (VAD) and Sequential Organ Failure Assessment (SOFA) score on admission were higher in ARRT patients (P = 0.009 and < 0.001, respectively). Basal estimated glomerular filtration rate (eGFR) was lower in the ARRT cohort (P < 0.001). Hospital and ICU length of stay were longer in the ARRT cohort (P < 0.001). Ninety-day mortality was 58.2% in the ARRT cohort compared to 55.8% in the non-ARRT control cohort (P = NS). In the survival analysis, only female sex, sepsis and non-renal SOFA ≥ 6.5 were significantly associated with mortality (P = 0.002, 0.028 and 0.009, respectively) in the ARRT cohort. CONCLUSION Mortality was not significantly increased in the octogenarian or older population that required and received ARRT compared to control patients who did not require it. Severity scores like SOFA could help in the process of decision making about initiation of ARRT in this population.
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Affiliation(s)
- Alícia Molina-Andújar
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Joaquim Casals
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Jimena Del Risco-Zevallos
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Evelyn Hermida
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Gaston Piñeiro
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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Oliveros H, Buitrago G. Effect of renal support therapy on 5-year survival in patients discharged from the intensive care unit. J Intensive Care 2020; 8:63. [PMID: 32832092 PMCID: PMC7437019 DOI: 10.1186/s40560-020-00481-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/10/2020] [Indexed: 01/12/2023] Open
Abstract
Background Between 30 and 70% of patients admitted to the intensive care unit (ICU) have acute kidney injury (AKI), and 10% of these patients will require renal replacement therapy (RRT). A significant number of studies have compared the mortality of patients who require RRT versus those who do not require it, finding an increase in mortality rates in the short and medium term; however, few studies have evaluated the long-term survival in a mixture of patients admitted to the ICU. Objective To evaluate the impact of RRT on 5-year survival in patients with AKI admitted to the ICU. Methods Using administrative databases of insurers of the Colombian health system, a cohort of patients admitted to the ICU between 1 January 2012 and 31 December 2013 was followed until 31 December 2018. ICD-10 diagnoses, procedure codes, and prescribed medications were used to establish the frequencies of the comorbidities included in the Charlson index. Patients were followed for at least 5 years to evaluate survival and establish the adjusted risks by propensity score matching. Results Of the 150,230 patients admitted to the ICU, 4366 (2.9%) required RRT in the ICU. Mortality rates for patients with RRT vs no RRT evaluated at ICU discharge, 1 year, and 5 years were 35%, 57.4%, and 67.9% vs 7.4%, 17.6%, and 30.1%, respectively. After propensity score matching, the hazard ratio was calculated for patients who received RRT and those who did not (HR, 2.46; 95% CI 2.37 to 2.56; p < 0.001), with a lower difference in years of survival for patients with RRT (mean effect in the treated) of - 1.86 (95% CI - 2.01 to to1.65; p < 0.001). Conclusions The impact of acute renal failure with the consequent need for RRT in patients admitted to the ICU is reflected in a decrease of approximately one quarter in 5-year survival, regardless of the different comorbidities.
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Affiliation(s)
- Henry Oliveros
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia.,School of Medicine, Universidad de la Sabana, Autonorte de Bogota Km 7, La Caro, Chía, Colombia
| | - Giancarlo Buitrago
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
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Sousa ALB, de Souza LM, Santana Filho OV, E Léda VHF, Rocha PN. Incidence, predictors and prognosis of acute kidney injury in nonagenarians: an in-hospital cohort study. BMC Nephrol 2020; 21:34. [PMID: 32000715 PMCID: PMC6993395 DOI: 10.1186/s12882-020-1698-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background Given the aging of the population, nephrologists are ever more frequently assisting nonagenarians with acute kidney injury (AKI). The management of these patients presents unique characteristics, including bioethical dilemmas, such as the utilization of renal replacement therapy (RRT) at this extreme age. Methods We conducted a retrospective cohort study at a tertiary hospital. Over a 10-year period, 832 nonagenarians were hospitalized for two or more days. A random sample of 461 patients was obtained; 25 subjects were excluded due to lack of essential data. AKI was defined and staged according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results We analyzed data from 436 patients, mean age 93.5 ± 3.3 years, 74.3% female; 76.4% required intensive care unit (ICU). The incidence of AKI was 45%. Length of hospital stay, ICU admission, vasopressors, and mechanical ventilation (MV) were independent predictors of AKI. Overall in-hospital mortality was 43.1%. Mortality was higher in the AKI compared to the no AKI group (66.8% vs. 23.8%, p < 0.001). Only 13 patients underwent RRT; all were critically ill, requiring vasopressors and 76.9% in MV. Mortality for this RRT group was 100% but not significantly higher than that observed in 26 non-RRT controls (96.1%, p = 1.0) obtained by proportional random sampling, matched by variables related to illness severity. In multivariable analysis, age, Charlson’s score, vasopressors, MV, and AKI – but not RRT – were independent predictors of mortality. Conclusions AKI is common in hospitalized nonagenarians and carries a grave prognosis, especially in those who are critically iil. The use of RRT was not able to change the fatal prognosis of this subgroup of patients. Our data may help guide informed decisions about the utility of RRT in this scenario.
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Affiliation(s)
- Andre Luis Bastos Sousa
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil.
| | - Leticia Mascarenhas de Souza
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil
| | - Osvaldino Vieira Santana Filho
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil
| | - Victor Hugo Ferreira E Léda
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil
| | - Paulo Novis Rocha
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil
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