Renal Function In Elderly Patients Research Articles

Utility of cystatin C and serum creatinine-based glomerular filtration rate equations in predicting vancomycin clearance: A population pharmacokinetics analysis in elderly Chinese patients.

Renal function is an important factor affecting the pharmacokinetics of vancomycin. The renal function in elderly patients gradually decreases with age. An accurate estimated glomerular filtration rate (GFR) is essential in drug dosing. The study aimed to determine the most appropriate renal function estimation equations to describe vancomycin pharmacokinetics in elderly patients using population pharmacokinetic analysis. Data were obtained retrospectively from elderly patients aged ≥65years who received vancomycin for infection from September 2016 to January 2022. Renal function was estimated using the Cockcroft-Gault equation (CG), Modification of Diet in Renal Disease equation (MDRD), three Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPIcys-scr , CKD-EPIscr , and CKD-EPIcys ) and two Berlin Initiative Study equations (BIS-1 and BIS-2). The CKD-EPIcys-scr and BIS-2 equations were based on cystatin C (Cys C) and serum creatinine (Scr). The others were based on Cys C or Scr. A nonlinear mixed effects model (NONMEM) was used to develop the population pharmacokinetic model. A total of 471 serum concentrations from 313 elderly patients were used to develop the population pharmacokinetic model. Weight and GFR were identified as significant covariates affecting the pharmacokinetics of vancomycin. Cys C and Scr-based GFR (CKD-EPIcys-scr and BIS-2) yielded significant improvement performance compared with the other equations in model building. The interindividual variability of CL was reduced from 49.4% to 23.6% and 49.4% to 23.7% in CKD-EPIcys-scr and BIS-2 based models, respectively. However, greater interindividual variabilities of CL (from 26.6% to 29.0%) were represented in the other five models which were based on either Cys C or Scr. The GFR estimated by EPIcys-scr and BIS-2 equations and vancomycin CL exhibited a good correlation (r=0.834 and 0.833). In the external validation with 124 serum concentrations, the predictive performances of the CKD-EPIcys-scr and BIS-2 based models (the mean relative prediction errors were less than 1%, the mean relative absolute prediction errors were about 23%) were also superior to the other five models (the mean relative prediction errors were about 2%, the mean relative absolute prediction errors were greater than 25%) which are based on either Cys C or Scr. In this study, we determined that the equation used to estimate GFR can affect the population pharmacokinetic model fitting result. Population pharmacokinetics model with CKD-EPIcys-scr or BIS-2 can be used to optimize vancomycin dosage in elderly Chinese patients.

Short and long-term renal function changes with direct oral anticoagulants in elderly patients with atrial fibrillation

Abstract Background Atrial Fibrillation (AF) and chronic kidney disease (CKD) frequently coexist in elderly patient. Previous evidence showed that vitamin K antagonists (VKAs) may be associated with an accelerated decrease of estimated glomerular filtration rate (eGFR) compared to direct oral anticoagulants (DOACs). However, there is little evidence on DOACs in the elderly population and in real life settings; the evidence available to us comes from randomized clinical trials with younger populations. Purpose The main objective of this study was to investigate the medium to long term renal function changes in older AF patients treated with DOACs and VKAs. Methods Enrolled patients underwent 3 eGFR measurements during follow-up, and the between arms difference in eGFR lost over time was investigated by 1) the Linear Mixed Models (LMM) and 2) group-based trajectory model (GBTM) analyses. Analysis was done according to short-term (3.2 years) and long-term follow-up (6.7 years). During the study period 420 enrolled AF patients (77.0±6.0 years, 136 on VKAs and 284 on DOACs) underwent 1260 eGFR assessments. Results After a median follow-up of 4.9 years, in the whole sample eGFR decreased from 67.4±18.2 ml/min/1.73 m2 to 47.1±14.3 ml/min/1.73 m2, p<0.001. Patients on DOACs experienced a significantly lower eGFR decrease that those treated with VKAs (-21.3% vs -45.1%, p<0.001). The benefit of DOACs compared with VKAs was evident both in the short term (eGFR decline -6.6 (95% CI: -9.1 to -4.0) ml/min/1.73 m2 vs -19.9 (95% CI: -23.6 to -16.2) ml/min/1.73 m2 respectively) and in the long-term, (eGFR -13.5 (95% CI: -16.1 to -11.0) ml/min/1.73 m2 in DOACs group vs -34.2 (95% CI: -37.9 to -30.5) ml/min/1.73 m2), respectively). After stratifying our study population into 5 groups according to trajectories of renal function decline, from the first (lowest decline in eGFR) to the fifth (greatest decline in eGFR), the first trajectory consisted of 80% patients on DOACs therapy. Logistic regression showed that the group on DOACs therapy was 3.03- to 4.24-fold more likely to belong to the trajectory with less eGFR decline than the VKAs group. Conclusions In conclusion, DOACs were associated with less long term decline in renal function in elderly patients with AF compared with VKAs.

Effects of entecavir and tenofovir alafenamide fumarate treatment on renal function in Japanese elderly patients with chronic hepatitis B.

Entecavir (ETV) and tenofovir alafenamide fumarate (TAF) are considered safe nucleoside/nucleotide analogs (NA) for the kidney. This study aimed to investigate the long-term effects of ETV or TAF on renal function in elderly patients with chronic hepatitis B (CHB) in Japan. The study included 246 CHB patients treated with ETV (184 patients) or TAF (62 patients) for at least 2years. These patients were divided into two groups: those <65years of age (130 patients) and those ≥65years of age (116 patients). The effects of the NAs on renal functions were examined by comparing the estimated glomerular filtration rates (eGFR) from baseline to 2years between the two groups. The change in eGFR from baseline to 1 or 2years after treatment was significantly decreased in both groups. However, the amount of change at 1 and 2years was significantly greater in the group aged ≥65years than in the group aged <65years. The amount of change in eGFR from baseline to 1 and 2years after treatment was significantly greater in the group aged ≥65years than in the group aged <65years, regardless of the type of NA, the prior treatment history, cirrhosis/chronic hepatitis, hypertension, dyslipidemia, and diabetes. Additionally, logistic regression analysis showed that age ≥65years was independently associated with a decreased eGFR after 2years of NA treatment. Long-term administration of NA to CHB patients over 65years of age should be carefully monitored for renal impairment.

Renal function in very old critically ill patients.

Current demographic change leads to higher number of elderly patients admitted to an ICU. Among other organs also the kidneys show age-related changes, which are associated with a decline in various aspects of renal function. The purpose of this review is to provide an overview of structural and functional changes in elderly and also to specifically address the increased risk of acute kidney injury (AKI) in this population. Ageing in the kidneys is affected by many different factors, such as low grade chronic inflammation, called inflammageing, and various comorbidities. Nevertheless, a decrease of glomerular filtration rate (GFR) occurs independent of the presence of comorbidities and a steady decline of GFR has been reported in both healthy men and women. Pharmacodynamic of many drugs is altered by these changes. Additionally the rate of diuretic resistance appears to be increased. The cause of AKI occurrence in older age is, multifactorial and includes preventable triggers (hypovolemia, hypotension, nephrotoxins) as well as changes associated with aging. Age-related alterations of the kidneys were found at microscopic and macroscopic levels of the cell. These changes lead to a reduced renal reserve and subsequently to an increased vulnerability of aged kidneys when an additional stressor is added. Age is an independent risk factor for developing AKI. Physicians should take into account the altered renal function in elderly patients and take renal protective measures at an early stage.

Evaluation of perioperative renal function in elderly patients with administration of hydroxyethyl starch (130/0.4) in below umbilicus orthopaedic surgery - Randomised controlled trial.

Evaluation of perioperative renal function in elderly patients with administration of hydroxyethyl starch (130/0.4) in below umbilicus orthopaedic surgery - Randomised controlled trial.

EVALUATION OF KIDNEY FUNCTION IN AN ELDERLY PATIENT WITH ACUTE MYELOBLASTIC LEUKEMIA AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION: A CASE REPORT

Relevance: Kidney functions in treating acute myeloblastic leukemia (AML) undergo serious effects, especially in elderly patients. Chemotherapeutic drugs used to prepare for hematopoietic stem cell transplantation (HSCT) inevitably affect elderly patients’ kidney function. Moreover, involutive changes in the kidneys can physiologically decrease kidney function.&#x0D; The study aimed to evaluate kidney function in an elderly patient with AML after HSCT.&#x0D; Methods: The article describes a clinical case of AML in an elderly patient who underwent allogeneic HSCT.&#x0D; Results: We analyzed the dynamics of the functional state from the moment of registration of AML to +100 days after HSCT. During the entire follow-up period, we did not detect any renal dysfunction in the elderly patient. Despite the HSCT and the effects of nephrotoxic drugs in an elderly patient + 100 days after HSCT, kidney function was preserved.&#x0D; Conclusion: The described case highlights the importance of maintaining renal function in elderly patients after HSCT and long-term renal monitoring.

EVALUATION OF KIDNEY FUNCTION IN AN ELDERLY PATIENT WITH ACUTE MYELOBLASTIC LEUKEMIA AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION: A CASE REPORT

Relevance: Kidney functions in treating acute myeloblastic leukemia (AML) undergo serious effects, especially in elderly patients. Chemotherapeutic drugs used to prepare for hematopoietic stem cell transplantation (HSCT) inevitably affect elderly patients’ kidney function. Moreover, involutive changes in the kidneys can physiologically decrease kidney function.&#x0D; The study aimed to evaluate kidney function in an elderly patient with AML after HSCT.&#x0D; Methods: The article describes a clinical case of AML in an elderly patient who underwent allogeneic HSCT.&#x0D; Results: We analyzed the dynamics of the functional state from the moment of registration of AML to +100 days after HSCT. During the entire follow-up period, we did not detect any renal dysfunction in the elderly patient. Despite the HSCT and the effects of nephrotoxic drugs in an elderly patient + 100 days after HSCT, kidney function was preserved.&#x0D; Conclusion: The described case highlights the importance of maintaining renal function in elderly patients after HSCT and long-term renal monitoring.

Association of serum N-terminal pro-brain natriuretic peptide levels with survival and renal outcomes among elderly patients with acute kidney injury in chronic heart failure.

Elderly patients exhibit a higher incidence of chronic heart failure (CHF). Patients with CHF can develop acute kidney injury (AKI) during follow-up, which can result in poor prognosis. This relationship between kidney dysfunction and levels of N-terminal pro-brain natriuretic peptides (NT-proBNP), with regard to prognosis, is complicated and has rarely been analyzed in elderly patients with CHF. We conducted a retrospective cohort study involving patients with a CHF history aged ≥ 65 years, who experienced an episode of AKI. Kaplan-Meier curves and Cox or logistic proportional hazards regression models were used to evaluate the association between serum NT-proBNP concentrations and mortality or renal recovery by day 90. A total of 1,160 eligible patients with AKI were available for the study. Of this sample, 41.5% of patients died within 90 days of the onset of AKI. Patients with a decreased change in NT-proBNP accompanying the episode of AKI had a lower risk (adjusted OR = 0.56, 95% CI = 0.34-0.91) of more severe AKI (stage 2 and 3 vs. stage 1). The more severe AKI were associated with higher mortality and non-recovery of renal function in elderly patients with CHF, independent of NT-proBNP levels. Elevated levels of baseline lnNT-proBNP (adjusted HR = 1.27, 95% CI = 1.17-1.38) predicted mortality in elderly patients with CHF within 90 days of AKI onset. Patients with a decrease in NT-proBNP accompanying AKI had a lower risk of mortality (adjusted HR = 0.62, 95% CI = 0.48-0.79). However, a decrease in NT-proBNP is a risk factor (adjusted OR = 1.59, 95% CI = 1.02-2.48) for the non-recovery of renal function following AKI-especially in elderly survivors with low baseline NT-proBNP levels. A decreased change in NT-proBNP maybe protective for elderly patients with CHF by improving survival outcomes and preventing severe AKI. However, an excessive decrease in NT-proBNP is a risk factor for the non-recovery of renal function following AKI. Avoiding excessive changes in NT-proBNP may be protective for survival and renal injury prognosis.

Correlation Between Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms and Renal Function in Elderly Men Aged 80 Years and Older.

To investigate the relationship between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and renal function in elderly men aged 80 years and older. We selected 389 elderly men aged 80-97 years with BPH/LUTS hospitalized at The Second Division of General Geriatrics, The First Affiliated Hospital of Zhengzhou University, between July 2018 and July 2020. In the cross-sectional study, patients were divided into the treatment (233 patients) and non-treatment (156 patients) groups based on whether they received treatment for BPH/LUTS. In the prospective self-case-control study, we included 129 of the non-treatment group patients who received oral BPH/LUTS medication and completed the 6-month outpatient follow-up. We compared prostate indicators and renal function in the cross-sectional study and baseline and after-treatment data in the prospective self-case-control study. Multiple linear regression analysis was performed for risk factors affecting renal function before and after BPH/LUTS treatment. In the cross-sectional study, renal function was significantly better in the treatment group than in the non-treatment group. In the subgroup analysis of the prospective self-case-control study, renal function significantly improved after treatment among patients with hypertension and those with chronic kidney disease (CKD) 3a, but not in the entire cohort. Multivariable linear regression analysis showed that hypertension (β=2.06, 95% CI 0.40 to 3.71) and CKD 3a (β=17.16, 95% CI 15.53 to 18.79) were independent risk factors for creatinine differences before and after treatment, whereas hypertension (β=-2.27, 95% CI -3.65 to -0.89), CKD 3a (β=-11.93, 95% CI -13.29 to -10.58), and baseline prostate volume (β=-0.11, 95% CI -0.20 to -0.02) were independent risk factors for estimated glomerular filtration rate differences before and after treatment. Treatment for moderate and severe BPH/LUTS can improve renal function in elderly patients with hypertension or CKD 3a.

Analysis of Effect of Rosuvastatin on Blood Lipid, Inflammatory Reaction and Renal Function in Elderly Patients with Coronary Heart Disease Undergoing Interventional Therapy

Analysis of Effect of Rosuvastatin on Blood Lipid, Inflammatory Reaction and Renal Function in Elderly Patients with Coronary Heart Disease Undergoing Interventional Therapy

Analysis of the Correlation between the Distribution of MTHFR Gene and the Severity and Renal Function of Elderly Patients with H-Type Hypertension.

In order to investigate the correlation between the distribution of methylenetetrahydrofolate reductase (MTHFR, MR) C677T gene and the severity of disease and renal function in elderly patients with H-type hypertension, a total of 170 patients with H-type hypertension admitted to our hospital from September 2020 to February 2021 and 173 elderly patients with non-H-type hypertension during the same period are selected as the research objects and are respectively included in the observation group and control group. Baseline data and distribution of MR C677T genotype are compared between the two groups, influencing factors of H-type hypertension are analyzed by logistic regression analysis, and differences and correlation of homocysteine (Hcy) and estimated glomerular filtration rate (eGFR) levels in different MR C677T genotypes are compared. The influence of MR C677T genotype on the severity and renal function of patients with H-type hypertension is further analyzed. There are many influencing factors for H-type hypertension, including advanced age, high-sodium diet, and MR TT genotype. Patients with hypertension with these risk factors should be monitored. H-type hypertension has a high frequency of carrying TT genotype and T allele, and the TT genotype in H-type hypertension will affect the Hcy and eGFR levels. Therefore, Hcy level of H-type hypertension patients with TT genotype should be actively controlled to help control the disease and reduce kidney damage. MR TT genotype can be used as a reference index in the early screening of H-type hypertension.

Evaluation of the Effect of Topiroxostat on Renal Function in Patients with Hyperuricemia: STOP-C Study, a Retrospective Observational Cohort Study.

BackgroundSerum uric acid-lowering therapy is associated with maintaining renal function.ObjectiveWe aimed to retrospectively evaluate renal function and serum uric acid in patients with hyperuricemia who received topiroxostat for over a year.MethodsMedical records of patients from 1 January, 2015 to 31 October, 2019 in our hospital were used. From the medical records, data of 100 patients with hyperuricemia treated with topiroxostat were extracted (67:33 male:female). The primary endpoints were changes in serum creatinine level and estimated glomerular filtration rate at 12 months after topiroxostat administration. The secondary endpoints were changes in serum creatinine, serum uric acid, and estimated glomerular filtration rate before and after topiroxostat administration.ResultsThe study mainly involved elderly individuals (77.2 ± 9.5 years). Forty-four patients administered uric acid-lowering drugs were switched to topiroxostat. After 12 months, the serum creatinine level and estimated glomerular filtration rate showed no significant changes from baseline; however, the serum uric acid level significantly decreased. The estimated glomerular filtration rate significantly decreased during the 6 months before topiroxostat administration (p < 0.001), but showed no significant change at 6 months after topiroxostat administration (p = 0.849).ConclusionsThis study revealed that topiroxostat use not only reduced the serum uric acid level but also maintained renal function in elderly patients with hyperuricemia in daily clinical practice.

Clinical Impact of Worsening Renal Function in Elderly Patients with Acute Decompensated Heart Failure.

Background and ObjectivesThe clinical significance of worsening renal function (WRF) in elderly patients with acute decompensated heart failure (ADHF) is not completely understood. We compared the clinical conditions between younger and elderly patients with ADHF after the appearance of WRF to establish its prognostic influence.MethodsWe included 654 consecutive patients (37% women) admitted for ADHF. We divided the patients into four groups according to their age (<80 years, under-80, n=331; ≥80 years, over-80, n=323) and to their WRF statuses (either WRF or non-WRF group). We defined WRF as an increase in serum creatinine level ≥0.3 mg/dL or ≥150% within 48 hours after hospital arrival (under-80, n=62; over-80, n=75). The primary endpoint was a composite of cardiac events within 1 year.ResultsThe survival analyses revealed that the WRF group had significantly more cardiac events than the non-WRF group in patients in the over-80 group (log-rank p=0.025), but not in those of the under-80 group (log-rank p=0.50). The patients in the over-80, WRF group presented more significant mean blood pressure (MBP) drops than those in the over-80 non-WRF group (p=0.003). Logistic regression analyses revealed that higher MBP at admission was a significant predictor of WRF.ConclusionsWRF is a predictor of poor outcomes in elderly patients with ADHF.

Early drop in systolic blood pressure, heart rate at admission, and their effects on worsening renal function in elderly patients with acute heart failure

BackgroundRegardless of patients’ baseline renal function, worsening renal function (WRF) during hospitalization is associated with poor outcomes. In individuals with acute heart failure (AHF), one predictor of WRF is an early drop in systolic blood pressure (SBP). Few studies have investigated WRF in elderly AHF patients or the influence of these patients’ heart rate (HR) at admission on the relationship between an early SBP drop SBP and the AHF.MethodsWe measured the SBP and HR of 245 elderly AHF inpatients (83 ± 6.0 years old, females 51%) at admission and another six times over the next 48 h. We defined ‘WRF’ as a serum creatinine increase ≥0.3 mg/dL by Day 5 post-admission. We calculated the ‘early SBP drop’ as the difference between the admission SBP value and the lowest value during the first 48 h of hospitalization.ResultsThere were significant differences between the 36 patients with WRF and the 209 patients without WRF: early SBP drop (51 vs. 33 mmHg, p < 0.01) and HR at admission (79 vs. 90 bpm, p < 0.05), respectively. In the multiple logistic regression analysis adjusted for the confounders, higher early SBP drop (p < 0.04) and lower HR at admission (p < 0.01) were significantly associated with WRF. No significant association was shown for the interaction term of early SBP drop × HR at admission with WRF.ConclusionsIn these elderly AHF patients, exaggerated early SBP drop and lower HR at admission were significant independent predictors of WRF, and these factors were additively associated with WRF.

Effect of continuous intraoperative infusion of methoxamine on renal function in elderly patients undergoing gastrointestinal tumor surgery: a randomized controlled trial

BackgroundAcute renal injury (AKI) caused by hypotension often occurs in elderly patients after gastrointestinal tumor surgery. Although vasoactive drugs can increase effective filtration pressure, they may increase renal vascular resistance and reduce renal blood flow. The effect of methoxamine on renal function is not clear.MethodsAfter obtaining written informed consent, 180 elderly patients undergoing elective gastrointestinal tumor surgery were randomly allocated into two groups: M group (continuous infusion of methoxamine at 2 μg/kg/min) and N group (continuous infusion of normal saline). The patients’ mean arterial pressure was maintained within 20% of baseline by a continuous infusion of methoxamine or normal saline. Maintenance fluid was kept at 5 mL/kg/h. According to Kidney disease improve global outcome (KDIGO) guidelines, creatinine was measured at 1, 2 and 7 days after operation, and urine volume at 6, 12 and 24 h after operation was measured to evaluate the occurrence of AKI. 162 patients were included in the final data analysis.ResultsSignificant differences in the incidence of postoperative Acute kidney injury (M group: 7.5%; N group: 18.3%; P < 0.05), the frequency of hypotension (M group: 1 [1–3]; N group: 3 [1–5]; P < 0.05), and the duration of intraoperative hypotension (M group: 2[0–10]; N group: 10 [5–16]; P < 0.05) were identified between the groups. Multivariate logistic regression analyses demonstrated that preoperative creatinine and the frequency of intraoperative hypotension were the common factors leading to the occurrence of postoperative AKI. The results of Cox multivariate analysis showed that age and AKI were independent risk factors for 30-day death.ConclusionCompared with the intraoperative continuous infusion of placebo and methoxamine, continuous infusion of 2 μg/kg/min methoxamine reduced the incidence of postoperative AKI and other clinical complications in elderly patients undergoing gastrointestinal surgery by raising blood pressure and improved the prognosis of patients.Trial registrationTrial registration: Chinese Clinical Trial Registry, ChiCTR1900020536, registered 7 January, 2019,

Factors Affecting Renal Function in Elderly Patients with Osteoarthritis

Factors Affecting Renal Function in Elderly Patients with Osteoarthritis

Analysis of perioperative parameters and renal function in elderly patients with clinical T1-T2 renal masses treated by partial nephrectomy and radical nephrectomy

Objective To compare the perioperative parameters and renal function in patients, whose aged was 65 year-old or above, with clinical T1-2 renal tumors undergoing partial nephrectomy (PN) or radical nephrectomy (RN). Methods A retrospective review of 469 patients, who underwent RN and PN in our center, was conducted from January 2012 to November 2018, icluding 247 in the RN group and 222 in the PN group. The RN group consisted of 170 male and 77 female patients, with the mean age of (70.96±5.21) year-old. 126 cases were found that the tumor located on the right side, with the median diameter of (4.93±2.03)cm. The median BMI, median R. E.N.A.L. score and pre-operation eGFR of the RN group were (24.4±3.1)kg/m2, 8.39±1.45) and (80.23±15.14) ml/(min·1.73m2), respectively. The PN group consisted of 150 male and 72 female patients, with the mean age of (70.23±4.62) years old. 108 patients had tumors on the left side while 114 on the right side, with the median diameter of (3.17±1.41) cm. The median BMI, median R. E.N.A.L score and pre-operation eGFR of the PN group were (23.5±3.2) kg/m2, (6.69±1.81) and (82.83±14.36) ml/(min·1.73m2), respectively. No statistical difference was noticed in the age, gender, tumor location and BMI between RN group and PN group(P>0.05). The PN group had smaller tumors and lower R. E.N.A.L. scores than the RN group(P<0.05). Various parameters were compared between the PN and RN groups, including operative duration, surgical procedure, intraoperative blood loss, perioperative blood transfusion, drainage tube removal time, postoperative duration of hospitalization, pathological results, the renal function immediately after surgery and at 1 month, 1 year, 2 years, 3 years, 4 years, 5 years after surgery, and the incidence of chronic renal dysfunction. Results Significant differences were found in multiple variables between the two cohorts, such as operative duration [(115.70±39.69)min in RN vs.(132.26±49.02) min in PN], estimated intraoperative blood loss [(45.85±55.93)days in RN vs. (66.60±61.55)ml in PN], drainage tube removal time [(4.38±1.71)days in RN vs.(4.86±1.61)days in PN], duration of postoperative hospitalization [(5.14±1.65)days in RN vs.(5.52±1.32)days in PN](P 0.05). Compared with the RN cohort, the PN cohort had higher eGFR immediately after surgery [(74.08±18.31)ml/(min·1.73m2) vs.(52.58±14.21) ml/(min·1.73m2)], 1 month after surgery [(76.11±18.34)ml/(min·1.73m2) vs.(53.78±15.03)ml/(min·1.73m2)] and at the last follow-up [(73.92±18.59)ml/(min·1.73m2)vs.(52.35±16.13)ml/(min·1.73m2)](P<0.001). Compared with those of the RN cohort, the incidences of eGFR<45 ml/(min·1.73m2) of the PN cohort were lower immediately after surgery [9.01% (20/222) vs. 31.9% (79/247)], 1 month after surgery [7.87% (14/178) vs. 27.31% (62/227)], 1 year after surgery [8.96% (13/145) vs.38.75% (62/160)], 2 years after surgery [9.89% (9/91) vs. 31.57% (42/133)], 3 years after surgery [13.21%(7/53) vs. 30.61% (30/98)], 4 years after surgery [16.21% (6/37) vs. 30.26% (23/76)] and 5 years after surgery [18.18% (4/22) vs. 31.11% (14/45)](P<0.001). Conclusion The perioperative risk of PN in the treatment of elderly patients aged 65 and above with clinical cT1-2 renal tumor is controllable. PN could better retain renal function for those patients and reduce the risk of postoperative chronic renal insufficiency. Key words: Elderly; Renal cell carcinoma; Partial nephrectomy; Radical nephrectomy; Renal function

Effects of iso-osmolar contrast media on renal function in elderly patients

Objective To investigate the effect of iso-osmolar contrast media (IOCM) on renal function in elderly patients. Methods The clinical data of 77 patients aged over 65 years undergoing vascular angiography and interventional therapy using IOCM with a dose>100 ml from September 2016 to May 2017 were retrospectively analyzed. Serum creatinine (CRE), urea and uric acid were measured before angiography, within 48 h and 3-7 d after angiography. The incidence of contrast-induced nephropathy (CIN) and the renal function before and after angiography were compared. Results Among the 77 patients, 58 were males and 19 were females, with an average age of (73.8±7.2) years. The mean serum CRE values before and 3-7 days after angiography were (84.55±39.92) μmol/L and (83.87±38.45) μmol/L respectively (t=0.140, P=0.889); the mean serum urea levels were (5.64±2.36) mmol/L and (6.44±3.15) mmol/L (t=3.041, P=0.003); the mean serum uric acid levels were (281.39±85.30) μmol/L and (333.29±89.89) μmol/L (t=7.297, P<0.001), respectively. CIN occurred in 7 patients with an incidence of 9.1%. In 7 patients with CIN, the mean CRE values increased from (135.71±102.41) μmol/L before angiography, to (180.00±100.45) μmol/L within 48 h and (142.86±92.97) μmol/L 3-7 d after angiography (F=9.876, P=0.011); and the uric acid levels progressively decreased from (353.43±86.73) μmol/L before angiography, to (339.14±85.69) μmol/L within 48 h after angiography and (299.57±95.71) μmol/L 3-7 d after angiography (F=5.713, P=0.029). Conclusion In elderly patients, IOCM has relatively mild effect on renal function during vascular angiography or interventional therapy. Key words: Contrast media; Aged; Acute kidney injury

Choice of Renal Function Estimator Influences Adverse Outcomes with Dabigatran Etexilate in Patients with Atrial Fibrillation.

Background Clinical significance of dosing dabigatran with different estimates of renal function for treatment of atrial fibrillation (AF) is unknown. Renal function is routinely estimated by the chronic kidney disease epidemiology initiative equation (CKD-EPI) and used to guide dosing. The aim of this study was to investigate the risk of adverse outcomes for patients with AF when different estimators of renal function are used. Material and Methods AF patient data were extracted from national administrative databases. Renal function was estimated using Cockcroft–Gault, CKD-EPI, and CKD-EPI adjusted for body surface area (CKD-EPI-BSA). Outcomes of cerebrovascular accident (CVA), systemic embolism (SE), and hemorrhage were extracted. Results In total, 2,425 patients were identified, of which there were hospitalizations for 138 (5.7%) hemorrhagic events, 45 (1.9%) CVA/SE, and 33 (1.4%) unspecified CVA. The level of agreement between Cockcroft–Gault with CKD-EPI and CKD-EPI-BSA yielded a weighted kappa statistic of 0.47 and 0.71, respectively. CKD-EPI and CKD-EPI-BSA significantly overestimated renal function in elderly patients resulting in higher recommended doses compared with Cockcroft–Gault. The hazard ratio for a hemorrhagic event was 2.32 (95% confidence interval, 1.22–4.42; p = 0.01) when a high dose was given compared with normal dose, based on Cockcroft–Gault. Conclusion Both CKD-EPI and CKD-EPI-BSA equations significantly overestimated renal function in the elderly population compared with the Cockcroft–Gault equation. This may lead to dose selection errors for dabigatran, particularly for those with severe impairment, increasing the risk of adverse outcome. Hence, CKD-EPI and CKD-EPI-BSA equations should not be substituted for the Cockcroft–Gault equation in the elderly for the purpose of renal dosage adjustments.

Effect of hemodiafiltration on renal function in elderly patients with uremia

Objective To investigate the effect of hemodiafiltration (HDF) on renal function in elderly patients with uremia. Methods From February 2015 to February 2017, 94 cases of elderly patients with uremia in our hospital were selected, among them, 45 cases were treated with HDF (HDF group), and 49 cases were received conventional hemodialysis (HD) (HD group), the levels of toxin and residual renal function were observed before and after dialysis in the two groups. Results Homocysteine (Hcy), parathyroid hormone (iPTH), urea nitrogen (BUN) and creatinine (Scr) of HDF group after dialysis 1 month were lower than pre dialysis (P<0.05). Hcy, BUN and Scr of HD group after dialysis 1 month were lower than pre-dialysis (P<0.05). Hcy, and iPTH of HDF group after dialysis 1 month were (24.08±4.52) mol/L and (1.63±0.70) g/L, significantly lower than that of HD group (P<0.05). After dialysis 1 month, residual renal urea clearance (KRU) of HDF group was (1.22±0.30) mL/min, significantly higher than the HD group (P<0.05). The complication rate of HDF group was 2.22%(1/45), which was significantly lower than that of HD group (P<0.05). Conclusions Compared with HD treatment, HDF can effectively remove the harmful substances in serum, and has little influence on the residual renal function of patients, less complications, it is worthy of clinical application. Key words: Uremia; Hemodiafiltration; Aged