MON-243 PARADIGM SHIFT IN CLINICAL PRESENTATION OF ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

Abstract

With aging, there is continuous and steady decline in glomerular filtration rate and especially elderly patients are at risk for renal dysfunction as well. In Indian subcontinent, due to lack of awareness and financial constraints most patients do not opt for any treatment. Also there is scarcity of data on etio-pathogenesis and prognosis of elderly patients with acute kidney injury (AKI). This was a prospective observational study carried out in 210 patients with clinical and laboratory evidence of renal dysfunction admitted at a tertiary care hospital. Patients were stratified by age (≤60 years, >60 years) as elderly and non-elderly. Patients who had AKI on admission were considered as community acquired (CA)- AKI. Patients who developed kidney injury after at least 24 hours of admission were referred as hospital acquired (HA)- AKI. Renal replacement therapy (RRT) was initiated for fluid overload, hyperkalemia, clinical evidence of uremia, metabolic acidosis and rapidly increasing serum Creatinine (SCr) level. Primary end-point was death or dialysis dependence at hospital discharge, secondary analyses includes length of stay in hospital and SCr at discharge. Out of 210 patients, 85 were elderly who had AKI, of which 74.5% had CA- AKI and 24.5% had hospital HA- AKI. Males comprised 63.6% of the patients while 37.3% were females. Sepsis associated AKI was most common cause (29.4%), followed by AKI in elderly diabetics (32.5%). Toxic AKI due to analgesics use (NSAIDs) and nephrotoxic antibiotics related acute renal dysfunction was observed in 27.9% elderly patients. Obstructive pyelonephritis related to stone disease was contributing to 18.4% cases of AKI. Multi-organ dysfunction was present in 47.3% patients. 79% patients required hemodialysis. About 43.6% showed complete recovery and 8.5% had partial recovery in renal function. The mortality in CA-AKI was higher compared to HA-AKI (34.5% versus 14.5%), and overall mortality was 49%. Comparing survivors with non-survivors, it was found that mortality was associated with delayed presentation (<6 vs >10 days), presence of hypotension (132/80 vs <90/70 mmHg), creatinine (9 vs 4 mg/dL), need for vasopressors (16% vs 56%) and higher Sequential Organ Failure Assessment (SOFA) score (5.9 vs 11.2). When comparing the primary end-point, the mortality was higher in elderly patients with AKI (younger, 20.4%; older, 48.0%). Also dependence on dialysis at discharge was more common among elderly population (younger, 10.3%; older, 38.0%) suggesting progression to chronic kidney disease. The AKI in elderly patients is associated with high morbidity and mortality compared to young individuals suggesting their poor tolerance of azotemia and needs more intensive care. Hence, treatment decisions should be individualized and meaningful and not only dependent on age as many elderly patients can recover well from AKI. More vigilance needed while treating elderly diabetics as they are more prone to have AKI.