Abstract
BackgroundPatients with chronic kidney disease tend to have impaired functional status, and this can increase the risk of morbidity and mortality. However, no previous studies have rigorously evaluated the relationship between incident acute kidney injury (AKI) and functional status of elderly patients.MethodsElderly patients (≥65 years-old) were prospectively from the general medical wards of a single medical center in Taiwan between January, 2014 and August, 2014. These patients were divided into those with and without AKI at initial presentation, according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Functional status was assessed by Barthel Index on admission. Multiple regression analyses were utilized to investigate the relationship between AKI and functional status.ResultsOne hundred and fifty-two elderly patients were recruited, 38.9 % of whom had AKI. Patients with AKI at admission had significantly higher mean Charlson Comorbidity Index score (p = 0.05) and borderline lower mean Barthel Index score (34.5 vs. 43.1; p = 0.08), and a significantly lower bladder continence subscale (5.4 vs. 7.0; p = 0.05). Multiple regression analyses indicated that the presence of AKI at admission was associated with a significantly lower Barthel Index score (p = 0.04). Increasing AKI severity (higher KDIGO stage) was also associated with significantly lower Barthel Index score (p <0.01).ConclusionsThis study documented a close relationship between AKI and functional status in the elderly. Interventions that aim to restore functional status might help to lower the risk of AKI in the elderly.
Highlights
Patients with chronic kidney disease tend to have impaired functional status, and this can increase the risk of morbidity and mortality
More than half of the enrolled patients had comorbid hypertension, 39 % had diabetes mellitus, 22 % had a history of cancer, and 22 % had chronic kidney disease (CKD)
Past reports indicated that elderly Taiwanese patients admitted to an emergency department had a mean Charlson comorbidity index of 3.1 ± 2.1 [15]
Summary
Patients with chronic kidney disease tend to have impaired functional status, and this can increase the risk of morbidity and mortality. No previous studies have rigorously evaluated the relationship between incident acute kidney injury (AKI) and functional status of elderly patients. A U.S study showed that the incidence of AKI increased progressively with age, from 13.6 per 1000 patient-years in Previous cross-sectional and longitudinal studies suggested an association between kidney impairment and risk of functional decline [6, 7]. Individuals with chronic kidney disease (CKD) have 40–70 % higher risk of functional limitation than those without CKD [7] The mechanism underlying this association has not been fully elucidated, but this relationship may involve traditional factors, such as cardiovascular diseases (hypertension, myocardial ischemia), cerebrovascular diseases, and diabetes mellitus, as well as non-traditional factors such as malnutrition-inflammation syndrome and depression [6, 7]
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