Abstract
BackgroundLikelihood of developing acute kidney injury (AKI) increases with age. We aimed to explore whether the predictability of AKI varies between age groups and assess the volatility of risk factors using electronic medical records (EMR).MethodsWe constructed a retrospective cohort of adult patients from all inpatient units of a tertiary care academic hospital and stratified it into four age groups: 18–35, 36–55, 56–65, and > 65. Potential risk factors collected from EMR for the study cohort included demographics, vital signs, medications, laboratory values, past medical diagnoses, and admission diagnoses. AKI was defined based on the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria. We analyzed relative importance of the risk factors in predicting AKI using Gradient Boosting Machine algorithm and explored the predictability of AKI across age groups using multiple machine learning models.ResultsIn our cohort, older patients showed a significantly higher incidence of AKI than younger adults: 18–35 (7.29%), 36–55 (8.82%), 56–65 (10.53%), and > 65 (10.55%) (p < 0.001). However, the predictability of AKI decreased with age, where the best cross-validated area under the receiver operating characteristic curve (AUROC) achieved for age groups 18–35, 36–55, 56–65, and > 65 were 0.784 (95% CI, 0.769–0.800), 0.766 (95% CI, 0.754–0.777), 0.754 (95% CI, 0.741–0.768), and 0.725 (95% CI, 0.709–0.737), respectively. We also observed that the relative risk of AKI predictors fluctuated between age groups.ConclusionsAs complexity of the cases increases with age, it is more difficult to quantify AKI risk for older adults in inpatient population.
Highlights
Likelihood of developing acute kidney injury (AKI) increases with age
Acute kidney injury (AKI) is associated with significant short- and long-term morbidity and mortality [2], and prevention is the best means for dealing with AKI
From a total of 179,370 encounters, we excluded those samples that lacked necessary data elements required to determine the outcome, that is, less than two serum creatinine measurements; and patients with evidences of moderate or severe kidney dysfunction at admission (estimated Glomerular Filtration Rate less than 60 mL/min/ 1.73 m2 or serum creatinine (SCr) level of > 1.3 mg/dL) were excluded. Estimated Glomerular Filtration Rate (eGFR) was calculated with the Modification of Diet in Renal Disease (MDRD) equation
Summary
Likelihood of developing acute kidney injury (AKI) increases with age. We aimed to explore whether the predictability of AKI varies between age groups and assess the volatility of risk factors using electronic medical records (EMR). Delays in identification and intervention for AKI may lead to rapid progression of the kidney injury, likelihood of developing chronic kidney disease (CKD), need for renal replacement therapy, and risk of death [3]. AKI is associated with various risk factors including inherent factors, exposure to nephrotoxins (e.g. non-steroidal anti-inflammatory drugs [6]), acute illnesses (e.g. sepsis [7]) and major surgeries (e.g. cardiopulmonary bypass or coronary angiography [8,9,10]). Inherent risk factors include susceptibilities of each individual patient (e.g. age [11]) and those associated with reduced kidney reserve or failure of other organs with known cross-talk with the kidneys (e.g. heart, liver, and respiratory system) [12]. Patients are at much higher risk for developing AKI due to their decreasing renal reserve and structural changes in the aged kidney that impair its ability to withstand and recover from injury [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
