Clinical Characteristics and Risk Factors for Mortality in Older Patients with Dialysis-Receiving Community-Acquired Acute Kidney Injury

Overview

Journal Int J Gen Med

Publisher Dove Medical Press

Specialty General Medicine

Date 2021 Sep 24

PMID 34557023

Authors

Guanglan Li

Xingji Lian

Wenke Hao

Wenxue Hu

Affiliations

Soon will be listed here.

Abstract

Introduction: Older people in community are susceptible to acute kidney injury (AKI) and hemodialysis is the most important supportive measure used in the management of severe AKI. This study aims to investigate the clinical characteristics, outcomes and risk factors for mortality in older patients with dialysis-receiving-community-acquired AKI (CA-AKI).

Methods: A total of 1953 CA-AKI patients aged 65 years old and above were recruited from 2013 to 2016. Among which, 200 patients received hemodialysis. Clinical characteristics, outcomes, suspected nephrotoxic drug use after CA-AKI and risk factors for mortality in older CA-AKI patients with dialysis were analyzed.

Results: The percentage of CA-AKI patients receiving hemodialysis was 10.2%. Compared with non-dialysis patients, dialysis-receiving patients had more comorbidity, and worse renal function. The types of suspected nephrotoxic drugs used in dialysis patients were more than those in non-dialysis patients. Moreover, dialysis-receiving patients had worse outcomes, including complete recovery of renal function (42.0% vs 71.6%), intensive care unit (ICU) (69.0% vs 15.3%) transfer and in-hospital mortality (50.5% vs 5.6%) (<0.01). Age, moderate/severe liver disease, beta lactam antibiotics, glycopeptide antibiotics, antifungal agents, drugs for anti-heart failure, category of suspected nephrotoxic drugs, hyperkalemia, increased leucocyte count, ICU transfer, multiple organ dysfunction (MODS), cardiogenic shock and cardio-pulmonary resuscitation (CPR) were risk factors for mortality by univariate logistic regression analysis. After adjusting for confounding factors, the independent risk factors were glycopeptide antibiotics, drugs for anti-heart failure, ICU transfer, MODS and CPR.

Conclusion: The percentage of older CA-AKI patients receiving dialysis was high, and these patients had more comorbidity and worse prognosis. Glycopeptide antibiotics, drugs for anti-heart failure, ICU transfer, MODS and CPR were independent risk factors for mortality.

References

Gyamlani G, Potukuchi P, Thomas F, Akbilgic O, Soohoo M, Streja E . Vancomycin-Associated Acute Kidney Injury in a Large Veteran Population. Am J Nephrol. 2019; 49(2):133-142. PMC: 6589826. DOI: 10.1159/000496484. View

Tollitt J, Bennett N, Darby D, Flanagan E, Chadwick P, Sinha S . The importance of acute kidney injury in suspected community acquired infection. PLoS One. 2019; 14(5):e0216412. PMC: 6504101. DOI: 10.1371/journal.pone.0216412. View

Robert L, Ficheur G, Gautier S, Servais A, Luyckx M, Soula J . Community-Acquired Acute Kidney Injury Induced By Drugs In Older Patients: A Multifactorial Event. Clin Interv Aging. 2019; 14:2105-2113. PMC: 6901120. DOI: 10.2147/CIA.S217567. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

Wilson F, Yang W, Feldman H . Predictors of death and dialysis in severe AKI: the UPHS-AKI cohort. Clin J Am Soc Nephrol. 2012; 8(4):527-37. PMC: 3613955. DOI: 10.2215/CJN.06450612. View

Khwaja A . KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120(4):c179-84. DOI: 10.1159/000339789. View

Denic A, Glassock R, Rule A . Structural and Functional Changes With the Aging Kidney. Adv Chronic Kidney Dis. 2015; 23(1):19-28. PMC: 4693148. DOI: 10.1053/j.ackd.2015.08.004. View

Kaaviya R, Vadivelan M, Balamurugan N, Parameswaran S, Thabah M . Community Acquired AKI: A Prospective Observational Study from a Tertiary Level Hospital in Southern India. Indian J Nephrol. 2019; 29(4):254-260. PMC: 6668316. DOI: 10.4103/ijn.IJN_238_18. View

Xu X, Nie S, Liu Z, Chen C, Xu G, Zha Y . Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults. Clin J Am Soc Nephrol. 2015; 10(9):1510-8. PMC: 4559507. DOI: 10.2215/CJN.02140215. View

10.

Wilson F, Yang W, Machado C, Mariani L, Borovskiy Y, Berns J . Dialysis versus nondialysis in patients with AKI: a propensity-matched cohort study. Clin J Am Soc Nephrol. 2014; 9(4):673-81. PMC: 3974360. DOI: 10.2215/CJN.07630713. View

11.

Gonzalez 3rd L, Spencer J . Aminoglycosides: a practical review. Am Fam Physician. 1998; 58(8):1811-20. View

12.

Sutherland S, Ji J, Sheikhi F, Widen E, Tian L, Alexander S . AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol. 2013; 8(10):1661-9. PMC: 3789331. DOI: 10.2215/CJN.00270113. View

13.

James M, Hemmelgarn B, Wiebe N, Pannu N, Manns B, Klarenbach S . Glomerular filtration rate, proteinuria, and the incidence and consequences of acute kidney injury: a cohort study. Lancet. 2010; 376(9758):2096-103. DOI: 10.1016/S0140-6736(10)61271-8. View

14.

Ge S, Nie S, Liu Z, Chen C, Zha Y, Qian J . Epidemiology and outcomes of acute kidney injury in elderly chinese patients: a subgroup analysis from the EACH study. BMC Nephrol. 2016; 17(1):136. PMC: 5041437. DOI: 10.1186/s12882-016-0351-2. View

15.

Zhang Q, Rothenbacher D . Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health. 2008; 8:117. PMC: 2377260. DOI: 10.1186/1471-2458-8-117. View

16.

Becker B, Cooper M . Aminoglycoside antibiotics in the 21st century. ACS Chem Biol. 2012; 8(1):105-15. DOI: 10.1021/cb3005116. View

17.

Baraldi A, Ballestri M, Rapana R, Lucchi L, Borella P, Leonelli M . Acute renal failure of medical type in an elderly population. Nephrol Dial Transplant. 1998; 13 Suppl 7:25-9. DOI: 10.1093/ndt/13.suppl_7.25. View

18.

Hu W, Lian X, Lin J, Chen Y, Wu Y, Liu W . The Incidence, Characteristics, and Use of Suspected Nephrotoxic Drugs in Elderly Patients with Community-Acquired Acute Kidney Injury. Clin Interv Aging. 2021; 16:35-42. PMC: 7800449. DOI: 10.2147/CIA.S286660. View

19.

Wald R, McArthur E, Adhikari N, Bagshaw S, Burns K, Garg A . Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis. 2014; 65(6):870-7. DOI: 10.1053/j.ajkd.2014.10.017. View

20.

Kovesdy C, Regidor D, Mehrotra R, Jing J, McAllister C, Greenland S . Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol. 2007; 2(5):999-1007. DOI: 10.2215/CJN.04451206. View