scholarly journals Is acute kidney injury age-dependent in older adults: an observational study in two centers from North China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Libin Xu ◽  
◽  
Yanhua Wu ◽  
Yuanhan Chen ◽  
Ruiying Li ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Kidney Injury ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Charlson Comorbidity Index Score ◽  
Hospital Death ◽  
Dependent Manner ◽  
Age Dependent

Abstract Background Although aging increases susceptibility to acute kidney injury (AKI), whether the AKI risk and the association between AKI and adverse outcomes are age-dependent remain unclear in older adults. The current study aimed to identify whether AKI risk was age-dependent in older adults and to investigate whether the association between AKI and mortality increased with increasing age. Methods Medical records from 47,012 adult hospital admissions, including 30,194 older adults aged 60 or older, in two tertiary general hospitals were studied retrospectively. AKI was identified based on changes in blood creatinine levels according to the Kidney Disease: Improving Global Outcomes criteria. Results Among the total population and 30,194 older adult patients, the raw incidences of AKI were 8.2 and 8.3%, respectively. The curve of the age-grouped AKI incidence was “U-shaped”, which revealed a positive relationship between the AKI incidence and age among the older adults aged 75 years or older. This trend of the age-AKI relationship was supported by further multivariable analysis. After adjusting for the Charlson Comorbidity Index score, the AKI was associated with in-hospital mortality; however, the associations did not increase with increasing age. Conclusion The AKI risk does not increase with age in older adults, except for those aged 75 and above. The association between AKI and in-hospital death did not increase in an age-dependent manner in older adults. Trial registration This study was retrospectively registered at clinicaltrials.gov (NCT03054142) on February 13, 2017.

scholarly journals Acute kidney injury and mortality risk in older adults with COVID-19

2021 ◽  
Vol 34 (2) ◽  
pp. 295-304
Author(s):  
Hong Xu ◽  
Sara Garcia-Ptacek ◽  
Martin Annetorp ◽  
Annette Bruchfeld ◽  
Tommy Cederholm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Acute Kidney Injury ◽  
Kidney Function ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Incidence Risk ◽  
The Difference ◽  
Hospitalized Older Adults

Abstract Background Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. Methods Observational study of patients admitted to two geriatric clinics in Stockholm from March 1st to June 15th, 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (OR) for the risk of AKI and in-hospital death were obtained from logistic regression. Results Three hundred-sixteen older patients were hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. AKI occurred in 92 (29%) patients with COVID-19 vs. 159 (18%) without COVID-19. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% confidence interval [CI] 1.04–2.76), low baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) [4.19 (2.48–7.05), for eGFR 30 to  < 60 mL/min, and 20.3 (9.95–41.3) for eGFR < 30 mL/min], and higher C reactive protein (CRP) (OR 1.81 (1.11–2.95) in patients with initial CRP > 10 mg/L). Compared to patients without COVID-19 and without AKI, the risk of in-hospital death was highest in patients with COVID-19 and AKI [OR 80.3, 95% CI (27.3–235.6)], followed by COVID-19 without AKI [16.3 (6.28–42.4)], and by patients without COVID-19 and with AKI [10.2 (3.66–28.2)]. Conclusions Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared to patients hospitalized for other diagnoses. COVID-19 and reduced baseline kidney function were risk factors for developing AKI. AKI and COVID-19 were associated with in-hospital death.

scholarly journals Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

2020 ◽  
Vol 45 (6) ◽  
pp. 1018-1032
Author(s):  
Imran Chaudhri ◽  
Richard Moffitt ◽  
Erin Taub ◽  
Raji R. Annadi ◽  
Minh Hoai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Hospital Death ◽  
Study Cohort ◽  
Icu Admission ◽  
Risk Of Death ◽  
Increased Risk

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. <b><i>Methods:</i></b> This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, <i>t</i> test, χ<sup>2</sup> test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. <b><i>Results:</i></b> Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, <i>p</i> = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). <b><i>Conclusion:</i></b> Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

scholarly journals Prospective GERiatric Observational (ProGERO) Study: Cohort Design and Preliminary Results

2020 ◽  
Author(s):  
Marcos Daniel Saraiva ◽  
Luís Fernando Rangel ◽  
Julia Lusis Lassance Cunha ◽  
Thereza Cristina Ariza Rotta ◽  
Christian Douradinho ◽  
...  
Keyword(s):  
Older Adults ◽  
Healthy Aging ◽  
Hospital Admissions ◽  
Handgrip Strength ◽  
Academic Medical Center ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Charlson Comorbidity Index Score ◽  
Study Cohort ◽  
Demographic Changes

Abstract Background: The demographic changes in Brazil as a result of population aging is one of the fastest in the world. The far-reaching new challenges that come with a large older population are particularly disquieting in low- and middle-income countries (LMICs). Longitudinal studies must be completed in LMICs to investigate the social and biological determinants of aging and the consequences of such demographic changes in their context. Therefore, we designed the Prospective GERiatric Observational (ProGERO) study, a longitudinal study of older adults in Brazil, to collect data both on healthy aging and chronic diseases, and investigate characteristics associated with adverse outcomes in this population. Methods: The ProGERO study takes place in a geriatric outpatient clinic in the largest academic medical center in Latin America. We performed baseline health examinations in 2017 and will complete subsequent in-person visits every three years when new participants will also be recruited. We will use periodic telephone interviews to collect information on the outcomes of interest between in-person visits. The baseline evaluation included data on demographics, medical history, physical examination, and comprehensive geriatric assessment (CGA; including multimorbidity, medications, social support, functional status, cognition, depressive symptoms, nutritional status, pain assessment, frailty, gait speed, handgrip strength, and chair-stands test). We used a previously validated CGA-based model to rank participants according to mortality risk (low, medium, high). Our selected outcomes were falls, disability, health services utilization (emergency room visits and hospital admissions), institutionalization, and death. We will follow participants for at least ten years.Results: We included 1,336 participants with a mean age of 82±8 years old. Overall, 70% were women, 31% were frail, and 43% had a Charlson comorbidity index score ≥3. According to our CGA-based model, the incidence of death in one year varied significantly across categories (low-risk=0.6%; medium-risk=7.4%; high-risk=17.5%; P<0.001).Conclusion: The ProGERO study will provide detailed clinical data and explore the late-life trajectories of community-dwelling older patients during a follow-up period of at least 10 years. Moreover, the study will substantially contribute to new information on the predictors of healthy and pathological aging in older adults from LMICs.

Abstract WMP100: Excessive Blood Pressure Reduction Increases the Risk of Acute Kidney Injury After Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kenichi Irie ◽  
Kaori Miwa ◽  
Kanta Tanaka ◽  
Hajime Ikenouchi ◽  
Masafumi Ihara ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Intracerebral Hemorrhage ◽  
Characteristic Curve ◽  
Blood Pressure Reduction ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospital Death ◽  
Stroke Registry ◽  
Increased Risk

Background: Elevated blood pressure (BP) in the first 24 hours of admission of acute intracerebral hemorrhage (ICH) has been the focus of intensive therapeutic investigation, although early intensive BP lowering addresses a concern about development of acute kidney injury (AKI). However, it is unclear as to the effect of BP measure including the absolute BP reduction and increased BP variability on AKI in patients with acute ICH. Methods: We retrieved data of consecutive patients with acute ICH from our prospective stroke registry between July 2015 and August 2017. We excluded patients with preexisting end-stage renal disease or in-hospital death within 24 hours. The primary outcome was AKI within 7days after admission defined using the AKI Network criteria. We recorded BP on emergency department arrival and for every 1 hour from 1 to 24 hours after admission (25 measurements). We measured mean systolic BP (SBP) and maximum minus minimum SBP within both 12 hours and 24 hours, and also quantified SBP variabilities (SBPV) including standard deviation, coefficient of variation, successive variation, and average real variability. Results: Among 361 patients with ICH (age 72.7±12.8, male 55%, non-lobar 76%), 31 (9%) developed AKI. For all SBP measure, the 12-hour SBP reduction was associated with the increased risk of AKI in multivariable analysis (odds ratio [per10 mmHg increase] 1.30; 95% CI 1.10-1.35). There was no significant association between the SBP variability and risk of AKI. The area under the receiver operating characteristic curve of the 12-hour SBP reduction for predicting AKI was 0.75. The association between the 12-hour SBP reduction and AKI was not modified by preexisting chronic kidney disease (interaction P=0.40). Conclusion: Early BP reduction in the first 12 hours of admission contributed to the risk of AKI in acute ICH. This may have clinical implication to avoid excess absolute BP reduction in patients with acute ICH.

Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults

2014 ◽  
Vol 161 (4) ◽  
pp. 242 ◽  
Author(s):  
Y. Joseph Hwang ◽  
Stephanie N. Dixon ◽  
Jeffrey P. Reiss ◽  
Ron Wald ◽  
Chirag R. Parikh ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Kidney Injury ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Atypical Antipsychotic Drugs

scholarly journals MO358ACUTE KIDNEY INJURY AND MORTALITY RISK IN OLDER ADULTS WITH AND WITHOUT COVID-19: DATA FROM GEROCOVID STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hong Xu ◽  
Sara Garcia-Ptacek ◽  
Martin Annetorp ◽  
Annette Bruchfeld ◽  
Tommy Cederholm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Kidney Function ◽  
Geriatric Patients ◽  
Vital Signs ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
The Difference ◽  
Hospitalized Older Adults

Abstract Background and Aims Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated the risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. Method Observational study of patients admitted to two geriatric clinics in the Stockholm Region of Sweden during the first wave of the COVID-19 pandemic from March 1st to June 15th 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (ORs) for AKI were obtained from logistic regressions. The hazard ratios (HRs) for the risk of in-hospital death were calculated from Cox proportional hazard regression models. Results We analyzed 316 older patients hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. The mean age was 83±9 years, 57% were women, and mean baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) was 62±23 ml/min/1.73m2. AKI occurred in 92 (29%) of patients with COVID-19 vs. 159 (18%) without COVID-19. The severity of AKI was significantly worse in patients with COVID-19 compared with non-COVID patients. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% CI, 1.04-2.76), low baseline kidney function [4.19 (2.48-7.05), for eGFR 30 ∼ &lt;60 ml/min/1.73m2, and 20.3 (9.95-41.3) for eGFR &lt;30ml/min/1.73m2], and higher C-reactive protein (CRP) level (OR 1.81(1.11-2.95)). The risk of in-hospital death was highest in patients with COVID-19 and AKI [adjusted HR 23.5, 95% CI (8.75-63.0)], followed by COVID-19 without AKI [9.10 (3.52-23.6)] and by patients without COVID-19 and with AKI [6.38 (2.28-17.9)] after adjusting for patient demographics, vital signs, baseline kidney function and medications and using non-COVID patients with no AKI as reference. Conclusion Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared with patients hospitalized with other diagnoses. AKI and COVID-19 were associated with in-hospital death. Optimal management of AKI may improve the outcome of COVID-19 in geriatric patients.

scholarly journals Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243528
Author(s):  
Jin Hyuk Paek ◽  
Yaerim Kim ◽  
Woo Yeong Park ◽  
Kyubok Jin ◽  
Miri Hyun ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospital Death ◽  
Kaplan Meier ◽  
Kdigo Guidelines ◽  
Independent Risk Factors ◽  
Elevated Creatinine ◽  
Stage 1

Although the lungs are major targets for COVID-19 invasion, other organs—such as the kidneys—are also affected. However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate its impact on patient outcomes. This retrospective study included 704 patients with COVID-19 who were hospitalized at two hospitals in Daegu, Korea from February 19 to March 31, 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The final date of follow-up was May 1, 2020. Of the 704 patients, 28 (4.0%) developed AKI. Of the 28 patients with AKI, 15 (53.6%) were found to have AKI stage 1, 3 (10.7%) had AKI stage 2, and 10 (35.7%) had AKI stage 3. Among these patients, 12 (42.9%) recovered from AKI. In the patients with AKI, the rates of admission to intensive care unit (ICU), administration of mechanical ventilator (MV), and in-hospital mortality were significantly higher than in patients without AKI. Multivariable analysis revealed that old age (Hazard ratio [HR] = 4.668, 95% confidence interval [CI] = 1.250–17.430, p = 0.022), high neutrophil-to-lymphocyte ratio (HR = 1.167, 95% CI = 1.078–1.264, p < 0.001), elevated creatinine kinase (HR = 1.002, 95% CI = 1.001–1.004, p = 0.007), and severe AKI (HR = 12.199, 95% CI = 4.235–35.141, p < 0.001) were independent risk factors for in-hospital mortality. The Kaplan-Meier curves showed that the cumulative survival rate was lowest in the AKI stage 3 group (p < 0.001). In conclusion, the incidence of AKI in patients with COVID-19 was 4.0%. Severe AKI was associated with in-hospital death.

Abstract 9381: Comparison of Clinical Characteristics and Adverse Outcomes in Pregnant Women with Cardiomyopathy Subtypes at the Time of Delivery in the US: 2006-2010

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fabio V Lima ◽  
Puja B Parikh ◽  
Jiawen Zhu ◽  
Jie Yang ◽  
Kathleen Stergiopoulos
Keyword(s):  
Heart Failure ◽  
Pregnant Women ◽  
Teaching Hospital ◽  
Clinical Characteristics ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Cerebrovascular Event

Introduction: Investigation of patient characteristics and outcomes in women with cardiomyopathy (CDM) at the time of delivery has been limited. The aim of this study was to determine the clinical characteristics and outcomes in women with peripartum (PCDM) and hypertrophic cardiomyopathy (HCDM), and the predictors for adverse clinical outcomes in pregnant women at the time of delivery. Methods and Results: The Healthcare Cost and Utilization Project’s National Inpatient Sample was screened for hospital admissions for delivery in pregnant women with CDM subtypes (peripartum, hypertrophic and all others) from 2006-2010. Clinical characteristics and maternal outcomes were identified in women with subtypes of CDM and without. The primary outcome of interest was major adverse clinical events (MACE), a composite of in-hospital death, acute myocardial infarction, heart failure, arrhythmia, cerebrovascular event, or embolic event. Our study population consisted of 2,078 patients with CDM and 4,438,439 patients without CDM. Of those with CDM, 52 (2.5%) had HCDM, 1039 (50.0%) had PCDM, and 987 (47.5%) were classified as other CDM (OCDM). PCDM cohort was more likely to be insured by Medicaid and the HCDM patients were more likely to deliver at a teaching hospital (p<0.01 for all). The PCDM and all OCDM cohorts had a larger proportion of black patients and most were from the South. PCDM patients experienced the highest rates of MACE (46%), compared with HCDM (23%) or OCDM (38.9%), mainly driven by heart failure and arrhythmia. Maternal mortality in all CDM subgroups was extremely low (< 0.5%). Significant predictors of MACE in the PCDM cohort were the presence of valvular heart disease (OR 2.16, 95% CI 1.49-3.14), severe pre-eclampsia (OR 1.54, 95% CI: 1.08-2.21), and Cesarean delivery (OR 1.36, 95% CI: 1.04-1.78); delivery at a teaching hospital was associated with a reduction in MACE. In multivariable analysis, the presence of PCDM (OR 2.22, 95% CI 1.07-4.55) was independently predictive of MACE. Conclusions: Peripartum CDM patients had the highest likelihood of MACE compared to hypertrophic and all other CDM subtypes.

scholarly journals Optimization of Acute Kidney Injury (AKI) Time Definitions Using the Electronic Health Record: A First Step in Automating In-Hospital AKI Detection

2021 ◽  
Vol 10 (15) ◽  
pp. 3304
Author(s):  
Joshua T. Swan ◽  
Linda W. Moore ◽  
Harlan G. Sparrow ◽  
Adaani E. Frost ◽  
A. Osama Gaber ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Admissions ◽  
Time Window ◽  
Time Windows ◽  
Kidney Injury ◽  
Hospital Death ◽  
Bootstrap Sampling ◽  
Observation Window ◽  
Adjusted Risk ◽  
Electronic Health

Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury (AKI) definitions were evaluated for cases detected and their respective outcomes using expanded time windows to 168 h. AKI incidence and outcomes with expanded time intervals were identified in the electronic health records (EHRs) from 126,367 unique adult hospital admissions (2012–2014) and evaluated using multivariable logistic regression with bootstrap sampling. The incidence of AKI detected was 7.4% (n = 9357) using a 24-h time window for both serum creatinine (SCr) criterion 1a (≥0.30 mg/dL) and 1b (≥50%) increases from index SCr, with additional cases of AKI identified: 6963 from 24–48 h.; 2509 for criterion 1b from 48 h to 7 days; 3004 cases (expansion of criterion 1a and 1b from 48 to 168 h). Compared to patients without AKI, adjusted hospital days increased if AKI (criterion 1a and 1b) was observed using a 24-h observation window (5.5 days), 48-h expansion (3.4 days), 48-h to 7-day expansion (6.5 days), and 168-h expansion (3.9 days); all are p < 0.001. Similarly, the adjusted risk of in-hospital death increased if AKI was detected using a 24-h observation window (odds ratio (OR) = 16.9), 48-h expansion (OR = 5.5), 48-h to 7-day expansion (OR = 4.2), and 168-h expansion (OR = 1.6); all are p ≤ 0.01. Expanding the time windows for both AKI SCr criteria 1a and 1b standardizes and facilitates EHR AKI detection, while identifying additional clinically relevant cases of in-hospital AKI.

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