nach oben

International Urology and Nephrology

Erschienen in:

05.05.2020 | Nephrology - Original Paper

In-hospital mortality in elderly patients with acute kidney injury requiring dialysis: a cohort analysis

verfasst von: Inês Duarte, Joana Gameiro, Cristina Resina, Cristina Outerelo

Erschienen in: International Urology and Nephrology | Ausgabe 6/2020

Einloggen, um Zugang zu erhalten

Abstract

Objective

To determine risk factors for in-hospital mortality in elderly patients with acute kidney injury (AKI) requiring dialysis.

Introduction

AKI requiring dialysis is frequent in elderly and is associated with an increased intra-hospital mortality. With the growing number of older individuals among hospitalized patients with AKI demands a thorough investigation of the factors that contribute to their mortality to improve outcomes.

Methods

We performed a retrospective analysis of patients older than 80 years, admitted due to AKI requiring dialysis between January 2016 and December 2017. Patients who need intensive-care units (ICU) admission were excluded. The primary outcome was all-cause in-hospital mortality.

Results

A total of 154 patients were evaluated. The mean age was 85.3 ± 4.0 years and 76 patients (49.4%) were male. The overall mortality rate was 26.6%. On the multivariate analysis, serum albumin (OR 0.42 [95% CI 0.21–0.85], p 0.016), C reactive protein/albumin ratio (OR 1.04 [95% CI 0.99–1.09], and renal function recovery (OR 018 [95% CI 0.49–0.65], p 0.009) were the factors associated with higher in-hospital mortality.

Conclusions

Lower albumin level, higher C reactive protein/albumin ratio at admission, and absence of renal function recovery are associated with increased in-hospital mortality’s risk in elderly with acute kidney injury requiring dialysis.

United Nations, Department of Economic and Social Affairs, Population Division (2017) World population ageing 2017 - highlights (ST/ESA/SER.A/397)

Wolff JL, Starfield B, Anderson G (2002) Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 162:2269–2276. https://doi.org/10.1001/archinte.162.20.2269 CrossRefPubMed

Marengoni A, Winblad B, Karp A, Fratiglioni L (2008) Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health 98:1198–1200. https://doi.org/10.2105/AJPH.2007.121137 CrossRefPubMedPubMedCentral

Xue JL, Daniels F, Star RA et al (2006) Incidence and mortality of acute renal failure in medicare beneficiaries, 1992–2001. J Am Soc Nephrol 17:1135–1142. https://doi.org/10.1681/ASN.2005060668 CrossRefPubMed

Feest TG, Round A, Hamad S (1993) Incidence of severe acute renal failure in adults: results of a community based study. BMJ 306:481–483. https://doi.org/10.1136/bmj.306.6876.481 CrossRefPubMedPubMedCentral

Pascual J, Orofino L, Liaño F et al (1990) Incidence and prognosis of acute renal failure in older patients. J Am Geriatr Soc 38:25–30. https://doi.org/10.1111/j.1532-5415.1990.tb01592.x CrossRefPubMed

Ali T, Khan I, Simpson W et al (2007) Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol 18:1292–1298. https://doi.org/10.1681/ASN.2006070756 CrossRefPubMed

United States Renal Data System (2018) 2018 USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD

Bradbury BD, Fissell RB, Albert JM et al (2007) Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol 2:89–99. https://doi.org/10.2215/CJN.01170905 CrossRefPubMed

10.

Khalil MAM, Awan S, Azmat R et al (2018) Factors affecting inpatient mortality in elderly people with acute kidney injury. Sci World J. https://doi.org/10.1155/2018/2142519 CrossRef

11.

Lukowsky LR, Kheifets L, Arah OA et al (2012) Patterns and predictors of early mortality in incident hemodialysis patients: new insights. Am J Nephrol 35:548–558. https://doi.org/10.1159/000338673 CrossRefPubMed

12.

Zhao X, Wang M, Zuo L (2017) Early mortality risk in incident Chinese hemodialysis patients: a retrospective cohort study. Ren Fail. https://doi.org/10.1080/0886022X.2017.1337583 CrossRefPubMedPubMedCentral

13.

Bae EH, Kim HY, Kang YU et al (2015) Risk factors for in-hospital mortality in patients starting hemodialysis. Kidney Res Clin Pract 34:154–159. https://doi.org/10.1016/j.krcp.2015.07.005 CrossRefPubMedPubMedCentral

14.

Couchoud C, Labeeuw M, Moranne O et al (2009) A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease. Nephrol Dial Transplant 24:1553–1561. https://doi.org/10.1093/ndt/gfn698 CrossRefPubMed

15.

Couchoud C, Hemmelgarn B, Kotanko P et al (2016) Supportive care: time to change our prognostic tools and their use in CKD. Clin J Am Soc Nephrol 11:1892–1901. https://doi.org/10.2215/CJN.12631115 CrossRefPubMedPubMedCentral

16.

Mauri JM, Vela E, Clèries M (2008) Development of a predictive model for early death in diabetic patients entering hemodialysis: a population-based study. Acta Diabetol 45:203–209. https://doi.org/10.1007/s00592-008-0043-x CrossRefPubMed

17.

Couchoud CG, Beuscart JBR, Aldigier JC et al (2015) Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int 88:1178–1186. https://doi.org/10.1038/ki.2015.245 CrossRefPubMed

18.

Thamer M, Kaufman JS, Zhang Yi, Zhang Q, Cotter DJBH (2015) Predicting early death among elderly dialysis patients: development and validation of a risk score to assist shared decision making for dialysis initiation. Am J Kidney Dis 66:1024–1032. https://doi.org/10.1053/j.ajkd.2015.05.014.Predicting CrossRefPubMedPubMedCentral

19.

Joly D, Anglicheau D, Alberti C et al (2003) Octogenarians reaching end-stage renal disease: cohort study of decision-making and clinical outcomes. J Am Soc Nephrol 14:1012–1021. https://doi.org/10.1097/01.ASN.0000054493.04151.80 CrossRefPubMed

20.

Kurella M, Covinsky KE, Collins AJ, Chertow GM (2007) Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med 146:177–184CrossRefPubMed

21.

Zhou T, Zhan J, Hong S et al (2015) Ratio of C-reactive protein/albumin is an inflammatory prognostic score for predicting overall survival of patients with small-cell lung cancer. Sci Rep 5:1–9. https://doi.org/10.1038/srep10481 CrossRef

22.

Ranzani OT, Zampieri FG, Forte DN et al (2013) C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE. https://doi.org/10.1371/journal.pone.0059321 CrossRefPubMedPubMedCentral

23.

Gupta D, Lis CG (2010) Pretreatment serum albumin as a predictor of cancer survival : A systematic review of the epidemiological literature. Nutr J 9:69. https://doi.org/10.1186/1475-2891-9-69 CrossRefPubMedPubMedCentral

24.

Kim MH, Ahn JY, Song JE et al (2015) The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe sepsis or septic shock treated with early goal-directed therapy. PLoS ONE 10:1–13. https://doi.org/10.1371/journal.pone.0132109 CrossRef

25.

Kaplan M, Ates I, Akpinar MY et al (2017) Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int 16:424–430. https://doi.org/10.1016/S1499-3872(17)60007-9 CrossRefPubMed

26.

Bozkurt E, Muhafiz E, Sengul D et al (2020) Can the CRP/albumin ratio be used as a new indicator of activation in patients with uveitis ? Can the CRP/albumin ratio be used as a new indicator of activation in patients with. Ocul Immunol Inflamm 00:1–6. https://doi.org/10.1080/09273948.2020.1714061 CrossRef

27.

Kinoshita A, Onoda H, Imai N et al (2015) The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 22:803–810. https://doi.org/10.1245/s10434-014-4048-0 CrossRefPubMed

28.

Chen Z, Shao Y, Fan M et al (2015) Prognostic significance of preoperative C-reactive protein: albumin ratio in patients with clear cell renal cell carcinoma. Int J Clin Exp Pathol 8:14893–14900PubMedPubMedCentral

29.

Xu XL, Yu HQ, Hu W et al (2015) A novel inflammation-based prognostic score, the c-reactive protein/albumin ratio predicts the prognosis of patients with operable esophageal squamous cell carcinoma. PLoS ONE 10:1–13. https://doi.org/10.1371/journal.pone.0138657 CrossRef

30.

Haruki K, Shiba H, Shirai Y et al (2016) The C-reactive protein to albumin ratio predicts long-term outcomes in patients with pancreatic cancer after pancreatic resection. World J Surg 40:2254–2260. https://doi.org/10.1007/s00268-016-3491-4 CrossRefPubMed

31.

Wu M, Guo J, Guo L, Zuo Q (2016) The C-reactive protein/albumin ratio predicts overall survival of patients with advanced pancreatic cancer. Tumor Biol 37:12525–12533. https://doi.org/10.1007/s13277-016-5122-y CrossRef

32.

Kidney Disease: Improving Global Outcomes (2013) KDIGO 2012 clinical practice guideline for acute kidney injury. Kidney Int Suppl. https://doi.org/10.1038/kisup.2012.3 CrossRef

33.

Kidney Disease: Improving Global Outcomes (2013) KDIGO 2012 clinical practice guideline for evaluation & management of CKD. Kidney Int Suppl. https://doi.org/10.1038/kisup.2012.76 CrossRef

34.

Care D, Suppl SS (2019) Classification and diagnosis of diabetes: Standards of medical care in diabetes. Diabetes Care 42:S13–S28. https://doi.org/10.2337/dc19-S002 CrossRef

35.

National High Blood Pressure Education Program (2004) The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. National Heart, Lung, and Blood Institute, Bethesda, MD

36.

Singer M, Deutschman C, Seymour CW et al (2016) The third international consensus definitions for sepsis. JAMA 315:801–810. https://doi.org/10.1001/jama.2016.0287.The CrossRefPubMedPubMedCentral

37.

Akposso K, Hertig A, Couprie R et al (2000) Acute renal failure in patients over 80 years old: 25-years’ experience. Intensive Care Med 26:400–406. https://doi.org/10.1007/s001340051173 CrossRefPubMed

38.

Pascual J, Liaio F, Study F (1998) Causes and prognosis of acute renal failure in the very old. Madrid Acute Renal Failure Study Group. J Am Geriatr Soc 46:721–725CrossRefPubMed

39.

Shusterman N, Strom BL, Murray TG et al (1987) Risk factors and outcome of hospital-acquired acute renal failure. Clinical Epidemiologic Study. Am J Med 83:65–71. https://doi.org/10.1016/0002-9343(87)90498-0 CrossRefPubMed

40.

Clermont G, Acker CG, Angus DC et al (2002) Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes. Kidney Int 62:986–996. https://doi.org/10.1046/j.1523-1755.2002.00509.x CrossRefPubMed

41.

Mehta RL, Pascual MT, Gruta CG et al (2002) Refining predictive models in critically ill patients with acute renal failure. J Am Soc Nephrol 13:1350–1357. https://doi.org/10.1097/01.ASN.0000014692.19351.52 CrossRefPubMed

42.

Wiedermann CJ, Wiedermann W, Joannidis M (2010) Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies. Intensive Care Med 36:1657–1665. https://doi.org/10.1007/s00134-010-1928-z CrossRefPubMedPubMedCentral

43.

Fiaccadori E, Cremaschi E (2009) Nutritional assessment and support in acute kidney injury. Curr Opin Crit Care 15:474–480. https://doi.org/10.1097/MCC.0b013e328332f6b2 CrossRefPubMed

44.

Obialo CI, Okonofua EC, Nzerue MC et al (1999) Role of hypoalbuminemia and hypocholesterolemia as copredictors of mortality in acute renal failure. Kidney Int 56:1058–1063. https://doi.org/10.1046/j.1523-1755.1999.00622.x CrossRefPubMed

45.

Fouque D, Kalantar-Zadeh K, Kopple J et al (2008) A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 73:391–398. https://doi.org/10.1038/sj.ki.5002585 CrossRefPubMed

46.

Alp Ikizler T (2012) The use and misuse of serum albumin as a nutritional marker in kidney disease. Clin J Am Soc Nephrol 7:1375–1377. https://doi.org/10.2215/CJN.07580712 CrossRefPubMed

47.

Jeejeebhoy KN (1998) Nutritional assessment. Gastroenterol Clin North Am 27:23. https://doi.org/10.1016/S0889-8553(05)70007-8 CrossRef

48.

Wagner D, Adunka C, Kniepeiss D et al (2011) Serum albumin, subjective global assessment, body mass index and the bioimpedance analysis in the assessment of malnutrition in patients up to 15 years after liver transplantation. Clin Transplant. https://doi.org/10.1111/j.1399-0012.2011.01442.x CrossRefPubMed

49.

Miho M, Masatoshi N, Maiko K, Takayuki H (2019) Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery. Sci Rep. https://doi.org/10.1038/s41598-019-56615-4 CrossRef

50.

Wiedermann CJ (2010) Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies. Intensive Care Med. https://doi.org/10.1007/s00134-010-1928-z CrossRefPubMedPubMedCentral

51.

Fiaccadori E, Lombardi M, Leonardi S et al (1999) Prevalence and clinical outcome associated with preexisting malnutrition in acute renal failure a prospective cohort study. J Am Soc Nephrol 10:581–593PubMed

52.

Simmons EM, Himmelfarb J, Tugrul Sezer M et al (2004) Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int 65:1357–1365. https://doi.org/10.1111/j.1523-1755.2004.00512.x CrossRefPubMed

53.

Fiaccadori E, Maggiore U, Cabassi A et al (2013) Nutritional evaluation and management of AKI patients. J Ren Nutr 23:255–258. https://doi.org/10.1053/j.jrn.2013.01.025 CrossRefPubMed

54.

Cosentino N, Genovese S, Campodonico J, Bonomi A, Lucci C, Milazzo V et al (2019) High-sensitivity C-reactive protein and acute kidney injury in patients with acute myocardial infarction: a prospective observational study. J Clin Med. https://doi.org/10.1007/s001340051173 CrossRefPubMedPubMedCentral

55.

Yang B, He Q, Ding C, Kang D, Tang Q (2019) High-sensitivity C-reactive protein as a predictive factor of acute kidney injury following aneurysmal subarachnoid hemorrhage: a prospective observational study. Acta Neurochir 161(9):1783–1791. https://doi.org/10.1007/s00701-019-04006-z CrossRefPubMed

56.

Tang Y, Mak S, Xu ANP, Lan H (2018) Role of C-reactive protein in the pathogenesis of acute kidney injury. Nephrology 4:50–52. https://doi.org/10.1111/nep.13454 CrossRef

57.

Pegues MA, McCrory MA, Zarjou A, Szalai AJ (2013) C-reactive protein exacerbates renal ischemia-reperfusion injury. Am J Physiol Physiol 304:F1358–F1365. https://doi.org/10.1152/ajprenal.00476.2012 CrossRef

58.

Tang Y, Huang XR, Lv J et al (2014) C-reactive protein promotes acute kidney injury by impairing G 1/S-dependent tubular epithelium cell regeneration. Clin Sci. 659:645–659. https://doi.org/10.1042/CS20130471 CrossRef

59.

Rencuzogullari I, Karaba Y, Metin C et al (2019) C-reactive protein/albumin ratio and stent restenosis infarction in patients with ST-segment elevation myocardial infarction. Rev Port Cardiol 38:269–277. https://doi.org/10.1016/j.repce.2019.05.014 CrossRefPubMed

60.

Satilmis S, Karabulut A (2020) Value of C-Reactive Protein / Albumin Ratio in Predicting the Development of Contrast- Induced Nephropathy in Patients With Non-ST Elevation Myocardial Infarction. Angiology. https://doi.org/10.1177/0003319719898057 CrossRefPubMed

61.

Xie Q, Zhou Y, Xu Z et al (2011) The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury. BMC Nephrol 12:30. https://doi.org/10.1186/1471-2369-12-30 CrossRefPubMedPubMedCentral

62.

Ronco C, Ferrari F, Ricci Z (2017) Recovery after acute kidney injury: a new prognostic dimension of the syndrome. Am J Respir Crit Care Med 195:711–714CrossRefPubMed

63.

Gaião SM, Gomes AA, De Carvalho Paiva JAO (2016) Prognostics factors for mortality and renal recovery in critically ill patients with acute kidney injury and renal replacement therapy. Rev Bras Ter Intensiva 28:70–77. https://doi.org/10.5935/0103-507X.20160015 CrossRefPubMedPubMedCentral

64.

Kellum JA, Sileanu FE, Bihorac A et al (2017) Recovery after acute kidney injury. Am J Respir Crit Care Med 195:784–791. https://doi.org/10.1159/000490007 CrossRefPubMedPubMedCentral

65.

Kalantar-zadeh K, Kilpatrick RD, Kuwae N et al (2005) Revisiting mortality predictability of serum albumin in the dialysis population : time dependency, longitudinal changes and population-attributable fraction. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfh941 CrossRefPubMed

66.

Mehta RL, Pascual MT, Soroko S et al (2004) Spectrum of acute renal failure in the intensive care unit: The PICARD experience. Kidney Int 66:1613–1621. https://doi.org/10.1111/j.1523-1755.2004.00927.x CrossRefPubMed

67.

Waikar SS, Curhan GC, Wald R et al (2006) Declining Mortality in patients with acute renal failure, 1988–2002. J Am Soc Nephrol 17:1143–1150. https://doi.org/10.1681/asn.2005091017 CrossRefPubMed

68.

Waikar SS, Liu KD, Chertow GM (2008) Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 3:844–861. https://doi.org/10.2215/CJN.05191107 CrossRefPubMed

Titel: In-hospital mortality in elderly patients with acute kidney injury requiring dialysis: a cohort analysis
verfasst von: Inês Duarte
Joana Gameiro
Cristina Resina
Cristina Outerelo
Publikationsdatum: 05.05.2020
Verlag: Springer Netherlands
Erschienen in: International Urology and Nephrology / Ausgabe 6/2020
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-020-02482-2

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

25.04.2024 | Hypotonie | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

In-hospital mortality in elderly patients with acute kidney injury requiring dialysis: a cohort analysis

Abstract

Objective

Introduction

Methods

Results

Conclusions

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Viel Bewegung in der Parkinsonforschung

Adjuvante Immuntherapie verlängert Leben bei RCC

Update Innere Medizin

Springer Medizin

Abstract

Objective

Introduction

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2020

RAS inhibition modulates kynurenine levels in a CKD population with and without type 2 diabetes mellitus

Association between albumin-to-globulin ratio and long-term mortality in patients with chronic kidney disease: a cohort study

Risk factors for decreased upper-limb muscle strength and its impact on survival in maintenance hemodialysis patients

The theoretical method and clinical application of testicular torsion

Development and validation of prognostic nomograms in patients with adrenocortical carcinoma: a population-based study

Interleukin 6 is a better predictor of 5-year cardiovascular mortality than high-sensitivity C-reactive protein in hemodialysis patients using reused low-flux dialyzers

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Viel Bewegung in der Parkinsonforschung

Adjuvante Immuntherapie verlängert Leben bei RCC

Update Innere Medizin