Acute kidney injury in elderly patients: narrative review on incidence, risk factors, and mortality

Abstract Objectives To investigate the incidence, risk factors and outcomes of acute kidney injury (AKI) in elderly patients undergoing abdominal surgery. Methods A retrospective study exploring the incidence of AKI in patients older than 75 years within 48 hours after abdominal surgery was conducted. Patients' preoperative characteristics, intraoperative management including medication and outcomes were evaluated for associations with AKI using a logistic regression model.Results During the 2.5-year period, a total of 409 abdominal surgeries were performed. Both pre- and post-operative SCr measurements were available for 329 (80.4%) cases. 26 patients (7.9%) developed AKI, of whom 25 (7.6%) and 1 (0.3%) reached the AKI stages 1 and 2 respectively. Older age (83.0 vs 80.4 years; p=0.002), preoperative liver function damage represented by AST (47.5 vs 21.0 IU/L; p=0.023), intraoperative combined administration of hydroxyethyl starch(HES) and furosemide (15.38% vs 1.65%; p=0.003) were independent risk factors for the development of postoperative AKI. Furthermore, AKI patients had significantly longer ICU stay (3 vs 0 days; p<0.001) and higher in-hospital mortality (23.08% vs 2.31%; p<0.001)Conclusion Intraoperative combined administration of HES and furosemide is an independent factor which can be controlled by anesthesiologists and surgeons for AKI. This provides important recommendations for reducing the incidence of postoperative AKI.

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Nutritional status and risk of contrast-associated acute kidney injury in elderly patients undergoing percutaneous coronary intervention

Clinical and Experimental Nephrology ◽

10.1007/s10157-021-02061-4 ◽

2021 ◽

Author(s):

Xiaoqi Wei ◽

Hanchuan Chen ◽

Zhebin You ◽

Jie Yang ◽

Haoming He ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Percutaneous Coronary Intervention ◽

Nutritional Status ◽

Elderly Patients ◽

Kidney Injury ◽

Coronary Intervention ◽

Severe Malnutrition ◽

Percutaneous Coronary ◽

Conut Score

Abstract Background This study aimed to investigate the connection between malnutrition evaluated by the Controlling Nutritional Status (CONUT) score and the risk of contrast-associated acute kidney injury (CA-AKI) in elderly patients who underwent percutaneous coronary intervention (PCI). Methods A total of 1308 patients aged over 75 years undergoing PCI was included. Based on the CONUT score, patients were assigned to normal (0–1), mild malnutrition (2–4), moderate-severe malnutrition group (≥ 5). The primary outcome was CA-AKI (an absolute increase in ≥ 0.3 mg/dL or ≥ 50% relative serum creatinine increase 48 h after contrast medium exposure). Results Overall, the incidence of CA-AKI in normal, mild, moderate-severe malnutrition group was 10.8%, 11.0%, and 27.2%, respectively (p < 0.01). Compared with moderate-severe malnutrition group, the normal group and the mild malnutrition group showed significant lower risk of CA-AKI in models adjusting for risk factors for CA-AKI and variables in univariate analysis (odds ratio [OR] = 0.48, 95% confidence interval [CI]: 0.26–0.89, p = 0.02; OR = 0.46, 95%CI: 0.26–0.82, p = 0.009, respectively). Furthermore, the relationship were consistent across the subgroups classified by risk factors for CA-AKI except anemia. The risk of CA-AKI related with CONUT score was stronger in patients with anemia. (overall interaction p by CONUT score = 0.012). Conclusion Moderate-severe malnutrition is associated with higher risk of CA-AKI in elderly patients undergoing PCI.

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