Abstract
Acute kidney injury (AKI) is associated with higher hospital mortality. However, the relationship between geriatric AKI and in-hospital complications is unclear. We prospectively enrolled elderly patients (≥65 years) from general medical wards of National Taiwan University Hospital, part of whom presented AKI at admission. We recorded subsequent in-hospital complications, including catastrophic events, incident gastrointestinal bleeding, hospital-associated infections, and new-onset electrolyte imbalances. Regression analyses were utilized to assess the associations between in-hospital complications and the initial AKI severity. A total of 163 elderly were recruited, with 39% presenting AKI (stage 1: 52%, stage 2: 23%, stage 3: 25%). The incidence of any in-hospital complication was significantly higher in the AKI group than in the non-AKI group (91% vs. 68%, p < 0.01). Multiple regression analyses indicated that elderly patients presenting with AKI had significantly higher risk of developing any complication (Odds ratio [OR] = 3.51, p = 0.01) and new-onset electrolyte imbalance (OR = 7.1, p < 0.01), and a trend toward more hospital-associated infections (OR = 1.99, p = 0.08). The risk of developing complications increased with higher AKI stage. In summary, our results indicate that initial AKI at admission in geriatric patients significantly increased the risk of in-hospital complications.
Highlights
A higher proportion of elderly acute kidney injury (AKI) patients develop chronic kidney disease (CKD) or end-stage renal disease (ESRD)[7,8]
A total of 163 elderly patients were prospectively enrolled during the 8-month study period, and 64 of these patients (39.3%) presented initially with AKI
Patients with AKI at presentation were significantly more likely to have chronic kidney disease (CKD) (p = 0.04), and CKD was more common in patients with more advanced AKI (p < 0.01)
Summary
A higher proportion of elderly AKI patients develop chronic kidney disease (CKD) or end-stage renal disease (ESRD)[7,8]. Previous studies of AKI in the elderly mostly examined short-term outcomes (in-hospital mortality) and long-term outcomes (renal prognosis, cardiovascular or all-cause mortality). The detrimental effects of AKI in geriatric patients might extend beyond survival or dependence on dialysis, because even mild renal insult in the elderly can have a negative impact[11,12]. Previous research suggests that more than half of hospitalized geriatric patients with AKI had stage I disease (defined by risk-injury-failure-loss-end stage [RIFLE] or acute kidney injury network [AKIN] staging)[11,12]. It is possible that milder degrees of AKI might confer a higher risk for adverse events in hospitalized elderly (such as in-hospital complications), in addition to survival. We investigated the relationship of severity of AKI in geriatric in-patients with subsequent complications during their hospitalization
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