Analysis of risk factors and clinical characteristics of elderly patients with persistent acute kidney injury

doi:10.3877/cma.j.issn.2095-3216.2019.06.006

Abstract

Abstract:

Objective

To investigate the incidence of transient acute kidney injury (AKI) and persistent AKI, the clinical characteristics of AKI patients, and the risk factors associated with persistent AKI in the elderly.

Methods

A retrospective analysis of 744 cases of ≥75-year-old inpatients who attended the National Geriatrics Clinical Research Center of the Chinese PLA General Hospital from January 2007 to December 2018. According to the recovery of serum creatinine (Scr) at 48 hours after AKI, the patients were divided into transient AKI group and persistent AKI group. SPSS 17.0 software was used for statistical analysis. Multivariate logistic regression method was used to analyze the risk factors related to persistent AKI in the elderly.

Results

Among the 744 cases of elderly patients with AKI, 701 cases were male (94.2%) with a median of 88 years (84-91). 8.3% of the patients suffered from transient AKI (62/744) and 91.7% of the patients persistent AKI (682/744). Compared with the transient group, the persistent AKI group showed a higher proportion of patients with a hypertension history (72.4% vs 83.9%, P=0.041), a higher 90-day mortality rate (37.4% vs 8.1%, P<0.001). a higher proportion of patients with AKI stage 3 (33.1% vs 8.1%, P<0.001), and higher levels of Scr (130.0 vs 116.1 μmol/L, P<0.001), peak Scr (147.6 vs 117.9 μmol/L, P<0.001), BUN (13.1 vs 9.3 mmol/L, P<0.001), serum uric acid (368.1 vs 338.3 μmol/L, P=0.006), and serum sodium (141 vs 138 mmol/L, P<0.001) on diagnosis of AKI. Compared with the transient group, the persistent AKI group also had more patients with mechanical ventilation (42.5% vs 12.9%, P<0.001), hypoalbuminemia (34.1±5.6 and 36.1±5.3 g/L, P=0.006), and anemia (111±22 vs 119±20 g/L, P=0.009). Multivariate logistic regression analysis showed that the peak Scr (OR=1.011, 95%CI: 1.004-1.019, P=0.002), increased serum sodium (OR=1.055, 95%CI: 1.015-1.097, P=0.007), and mechanical ventilation (OR=2.912, 95%CI: 1.334-6.357, P=0.007) were independent risk factors for the development of persistent AKI in the elderly patients.

Conclusion

The incidence of persistent AKI in the elderly patients was as high as 92%, and early diagnosis and treatment of risk factors could reduce persistent kidney damage.

Key words: Acute kidney injury, Transient AKI, Persistent AKI, Elderly, Risk factor

Qi Xiong, Xiaofei Fu, Xiaodan Wang. Analysis of risk factors and clinical characteristics of elderly patients with persistent acute kidney injury[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(06): 258-262.

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References 21

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组别	例数	一般情况			基础疾病及肾功能
组别	例数	年龄(岁)	男性[例(%)]	BMI(kg/m²)	冠心病	COPD	高血压	糖尿病	基础Scr(μmol/L)	基础eGFR
短暂AKI	62	87(84～91)	57 (91.9)	22.6±4.1	51(82.3)	43(69.4)	52(83.9)	26(41.9)	70.0(60.0～80.0)	80.2(75.0～85.5)
持续AKI	682	88(84～91)	644 (94.4)	23.0±3.0	514(75.4)	468(68.6)	494(72.4)	257(37.7)	72.0(60.0～83.0)	78.6(71.8～85.3)
t值或χ²值	－	－0.753	0.587	0.823	1.477	0.014	4.187	0.436	－0.780	－0.948
P值	－	0.451	0.443	0.413	0.224	0.905	0.041	0.509	0.435	0.343

组别	例数	一般情况			基础疾病及肾功能
组别	例数	年龄(岁)	男性[例(%)]	BMI(kg/m²)	冠心病	COPD	高血压	糖尿病	基础Scr(μmol/L)	基础eGFR
短暂AKI	62	87(84～91)	57 (91.9)	22.6±4.1	51(82.3)	43(69.4)	52(83.9)	26(41.9)	70.0(60.0～80.0)	80.2(75.0～85.5)
持续AKI	682	88(84～91)	644 (94.4)	23.0±3.0	514(75.4)	468(68.6)	494(72.4)	257(37.7)	72.0(60.0～83.0)	78.6(71.8～85.3)
t值或χ²值	－	－0.753	0.587	0.823	1.477	0.014	4.187	0.436	－0.780	－0.948
P值	－	0.451	0.443	0.413	0.224	0.905	0.041	0.509	0.435	0.343

组别	例数	AKI病因						伴随情况
组别	例数	脓毒症	低血容量	心血管事件	肾毒性药物	手术	其他	少尿	机械通气	平均动脉压
短暂AKI	62	19 (30.6)	12 (19.4)	15(24.2)	4(6.5)	9(14.5)	3(4.8)	2(3.2)	8(12.9)	81±14
持续AKI	682	29(43.0)	147(21.6)	96(14.1)	85(12.5)	40(5.9)	21(3.1)	44(6.5)	290(42.5)	78±14
t值或χ²值	－	3.541	0.164	4.583	1.950	5.419	0.497	1.205	20.765	－1.572
P值	－	0.060	0.686	0.032	0.163	0.020	0.481	0.272	<0.001	0.116
组别	例数	AKI确诊时实验室检查结果
组别	例数	Scr(μmol/L)	Scr峰值(μmol/L)	BUN(mmol/L)	血尿酸(μmol/L)	血钠(mmol/L)	血清白蛋白(g/L)	血清前白蛋白(g/L)	血红蛋白(g/L)
短暂AKI	62	116.1(107.0～134.9)	117.9(109.8～136.2)	9.3(7.2～12.8)	338.3(268.9～419.4)	138.0(132.0～142.0)	36.1±5.3	187(143～235)	119±20
持续AKI	682	130.0(116.0～146.0)	147.6(126.0～213.3)	13.1(9.2～21.4)	368.1(294.7～471.5)	141.0(136.0～147.0)	34.1±5.6	174(134～227)	111±22
t值或χ²值	－	－3.652	－6.429	－4.719	－2.693	－3.649	－2.780	－1.260	－2.606
P值	－	<0.001	<0.001	<0.001	0.006	<0.001	0.006	0.208	0.009
组别	例数	AKI分期			90 d结局
组别	例数	1期	2期	3期	病死率	透析
短暂AKI	62	39(62.9)	18(29.0)	5(8.1)	5(8.1)	0
持续AKI	682	284(41.6)	172(25.2)	226(33.1)	255(37.4)	4(0.6)
t值或χ²值	－	17.749			21.499	0.698
P值	－	<0.001			<0.001	0.403

组别	例数	AKI病因						伴随情况
组别	例数	脓毒症	低血容量	心血管事件	肾毒性药物	手术	其他	少尿	机械通气	平均动脉压
短暂AKI	62	19 (30.6)	12 (19.4)	15(24.2)	4(6.5)	9(14.5)	3(4.8)	2(3.2)	8(12.9)	81±14
持续AKI	682	29(43.0)	147(21.6)	96(14.1)	85(12.5)	40(5.9)	21(3.1)	44(6.5)	290(42.5)	78±14
t值或χ²值	－	3.541	0.164	4.583	1.950	5.419	0.497	1.205	20.765	－1.572
P值	－	0.060	0.686	0.032	0.163	0.020	0.481	0.272	<0.001	0.116
组别	例数	AKI确诊时实验室检查结果
组别	例数	Scr(μmol/L)	Scr峰值(μmol/L)	BUN(mmol/L)	血尿酸(μmol/L)	血钠(mmol/L)	血清白蛋白(g/L)	血清前白蛋白(g/L)	血红蛋白(g/L)
短暂AKI	62	116.1(107.0～134.9)	117.9(109.8～136.2)	9.3(7.2～12.8)	338.3(268.9～419.4)	138.0(132.0～142.0)	36.1±5.3	187(143～235)	119±20
持续AKI	682	130.0(116.0～146.0)	147.6(126.0～213.3)	13.1(9.2～21.4)	368.1(294.7～471.5)	141.0(136.0～147.0)	34.1±5.6	174(134～227)	111±22
t值或χ²值	－	－3.652	－6.429	－4.719	－2.693	－3.649	－2.780	－1.260	－2.606
P值	－	<0.001	<0.001	<0.001	0.006	<0.001	0.006	0.208	0.009
组别	例数	AKI分期			90 d结局
组别	例数	1期	2期	3期	病死率	透析
短暂AKI	62	39(62.9)	18(29.0)	5(8.1)	5(8.1)	0
持续AKI	682	284(41.6)	172(25.2)	226(33.1)	255(37.4)	4(0.6)
t值或χ²值	－	17.749			21.499	0.698
P值	－	<0.001			<0.001	0.403

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