#3600 ACUTE KIDNEY INJURY IN THE ELDERLY: DIFFERENCES OVER TIME

Abstract

Abstract Background and Aims The incidence of acute kidney injury (AKI) in people older than 60 years constantly increasing and it is higher than in the rest of the population. Increased risk of AKI in the elderly is due to decreased functional reserves of the kidneys, aggressive surgical and diagnostic interventions, and frequent use of nephrotoxic drugs. The aim of this study was to analyze the incidence and causes of AKI in a patient older than 60 years during three different periods: the first period between 1974-1994 year, the second between 1997-2001 year, and the third period between 2014-2018 year. At the same time, we examined the most common causes of AKI over time. Method The retrospective study included 927 patients with AKI treated in our clinic, 572 patients during the first period, 75 patients during the second period, and 280 patients in the third period. The diagnosis was made based on an absolute increase in serum creatinine by>26.5 umol/l, or an increase of 50% relative to basal values, or a decrease in urine output <0.5 ml/kg/h within 6 h. We analyzed causes and type of AKI, method of treatment, and mortality. Results Incidence of AKI in patients older than 60 years in the period 1974-1994 is 19%, only three years later this percentage has risen to 64%, while in the last period this percentage was 82%. Conservative method of treatment was more often used in the last examined period 83.6% compared to 33% and 56.2% in previous periods. In the last examined period, HD was used in 16.4% of patients (in two previous periods 4% and 8.3% respectively). While PD was used by 50.5% in the period 1997-2001 and 31.3% in the period 1974-1994, in the last period PD was not used. Mortality has declined slightly over time but remains high (27.1%, then 29.6%, and recently 22%). Regarding the type of AKI during all three examined periods, statistically the most common is the prerenal type over 50%, and the renal type during the last five-year period increased by 26.4% compared to the previous 17.5% and 20.8% respectively. Conclusion The incidence of AKI in people over the age of 60 is on the rise. Mortality, although still high, is noticeably declining compared to the previous periods, which may be a consequence of better treatment of both conservative and active dialysis treatment.