Causes of acute kidney injury in elderly in an acute medical setting

Abstract

Objective.– Little data exists about the causes of acute kidney injury (AKI) in the elderly (≥65years) presenting to the acute medical admissions unit (MAU). We explored the observational data from our hospital. Methods.– Retrospective data was collected from case notes identified from coding department. All patients with a primary diagnosis of AKI as the index cause of admission were included for first 4months of 2013. Results.– Two hundred and two patients – 192 were ≥65years old. Pre-renal, intrinsic renal and post-renal causes were observed. 88.6% (179/202) had a pre-renal cause – 88% (169/192) were ≥65years. 81.7% (165/202) had dehydration – 65.6% (126/192) were ≥65years. Fifty-four percent (109/202) had sepsis – 53.6% (103/192) were ≥65years. 7.4% (15/202) had hypotension and all were ≥65years. Only 1.9% (4/202) patients had a combination of all three and all were≥65years. 33.7% (68/202) had a combination of dehydration and sepsis – 33.3% (64/192) were ≥65years. One percent (2/202) had a combination of dehydration and hypotension – both ≥65years. 1.5% (3/202) had a combination of sepsis and hypotension and all were ≥65years. 62.4% (126/202) had AKI due to nephrotoxins – 64.6% (124/192)were≥65years and the two younger patients had contrast related nephropathy. Four out of 202 patients had vasculitis – 1/202had amyeloma– allwere≥65years. 12.8% (12/94) had enlarged prostate – all ≥65years. Conclusions.– Patients were predominantly ≥65years. Data from our cohort revealed that the predominant cause of AKI was prerenal. AKI due to nephrotoxins and pharmacological agents are also a significant cause of morbidity.