Analysis of occurrence and clinical characteristics of transient and persistent acute kidney injury in hospitalized elderly patients

doi:10.3877/cma.j.issn.2095-3216.2018.05.001

Abstract

Abstract:

Objective

We aimed to study the incidence, clinical characteristics, and risk factors of transient and persistent acute kidney injury (AKI) in very elderly patients.

Methods

We retrospectively enrolled very elderly patients (aged ≥75 years) from the Geriatric Department of the Chinese PLA General Hospital between January 2007 and December 2015. AKI patients were divided into transient or persistent AKI groups based on their renal function at 3 days post-AKI. Multivariate logistic regression analysis was made for the risk factors associated with persistent AKI in the elderly.

Results

During the study period, a total of 652 inpatients developed AKI, including 623 males, accounting for 95.6%, with a median age of 87 (84-91) years. Of the 652 patients with AKI, transient AKI occurred in 270 cases (41.4%) and persistent AKI in 382 cases (58.6%). Multivariate logistic regression analysis showed that the Scr peak value (OR=1.020; 95%CI: 1.015-1.026; P<0.001), the increase of blood urea nitrogen (BUN) (OR=1.028; 95%CI: 1.000-1.056; P=0.047), the increase of uric acid (OR=1.002; 95%CI: 1.000-1.003; P=0.040), and the requirement of mechanical ventilation (OR=1.610; 95%CI: 1.012-2.562; P=0.044) were independent risk factors of the persistent AKI in the elderly patients, while the increase of mean arterial pressure (OR=0.985; 95%CI: 0.971-1.000; P=0.043) and elevation of hemoglobin (OR=0.989; 95%CI: 0.980- 0.999; P=0.025) were independent protective factors for persistent AKI in the elderly patients.

Conclusions

The incidence of transient AKI in the elderly patients was as high as 42%. Increasing the attention of clinicians, and increasing the frequency of monitoring Scr were effective methods to reduce the rate of missed diagnosis for AKI. Early identification of the risk factors might improve the short-term outcomes of patients with AKI.

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

Qinglin Li, Yuru Li, Feihu Zhou. Analysis of occurrence and clinical characteristics of transient and persistent acute kidney injury in hospitalized elderly patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2018, 07(05): 193-198.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3216.2018.05.001

https://zhsbyjdzzz.cma-cmc.com.cn/EN/Y2018/V07/I05/193

Figures/Tables 3

References 26

[1]	Choi JS, Kim YA, Kim MJ, et al. Relation between transient or persistent acute kidney injury and long-term mortality in patients with myocardial infarction [J]. Am J Cardiol, 2013, 112(1): 41-45.
[2]	Wehbe E, Duncan AE, Dar G, et al. Recovery from AKI and short- and long-term outcomes after lung transplantation [J]. Clin J Am Soc Nephrol, 2013, 8(1): 19-25.
[3]	Ponce D, Kim CS, Bae EH, et al. Impact of transient and persistent acute kidney injury on chronic kidney disease progression and mortality after gastric surgery for gastric cancer [J]. PLoS One, 2016, 11(12): e0168119.
[4]	Kellum JA, Sileanu FE, Murugan R, et al. Classifying AKI by urine output versus serum creatinine level [J]. J Am Soc Nephrol, 2015, 26(9): 2231-2238.
[5]	Xu X, Nie S, Liu Z, et al. Epidemiology and clinical correlates of AKI in chinese hospitalized adults [J]. Clin J Am Soc Nephrol, 2015, 10(9): 1510-1518.
[6]	Pan HC, Chien YS, Jenq CC, et al. Acute kidney injury classification for critically ill cirrhotic patients: a comparison of the KDIGO, AKIN, and RIFLE classifications [J]. Sci Rep, 2016, 6: 23022.
[7]	Sutherland SM, Byrnes JJ, Kothari M, et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions [J]. Clin J Am Soc Nephrol, 2015, 10(4): 554-561.
[8]	Liborio AB, Leite TT, Neves FM, et al. AKI complications in critically ill patients: association with mortality rates and RRT [J]. Clin J Am Soc Nephrol, 2015, 10(1): 21-28.
[9]	Zeng X, McMahon GM, Brunelli SM, et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals [J]. Clin J Am Soc Nephrol, 2014, 9(1): 12-20.
[10]	Rewa O, Bagshaw SM. Acute kidney injury-epidemiology, outcomes and economics [J]. Nat Rev Nephrol, 2014, 10(4): 193-207.
[11]	Thakar CV, Christianson A, Freyberg R, et al. Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study [J]. Crit Care Med, 2009, 37(9): 2552-2558.
[12]	Perinel S, Vincent F, Lautrette A, et al. Transient and persistent acute kidney injury and the risk of hospital mortality in critically ill patients: results of a multicenter cohort study [J]. Crit Care Med, 2015, 43(8): e269-e275.
[13]	Eknoyan G, Lameire N, Eckardt K, et al. KDIGO clinical practice guideline for acute kidney injury [J]. Kidney Int Suppl, 2012, 2(1): 1-138.
[14]	Levin A, Stevens PE. Summary of KDIGO 2012 CKD guideline: behind the scenes, need for guidance, and a framework for moving forward [J]. Kidney Int, 2014, 85(1): 49-61.
[15]	Chao CT, Tsai HB, Wu CY, et al. The severity of initial acute kidney injury at admission of geriatric patients significantly correlates with subsequent in-hospital complications [J]. Sci Rep, 2015, 5: 13925.
[16]	Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate [J]. Ann Intern Med, 2009, 150(9): 604-612.
[17]	Lewington AJ, Cerda J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer [J]. Kidney Int, 2013, 84(3): 457-467.
[18]	Mehta RL, Cerdá J, Burdmann EA, et al. International Society of Nephrology′s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology [J]. Lancet, 2015, 385(9987): 2616-2643.
[19]	Yang L, Xing G, Wang L, et al. Acute kidney injury in China: a cross-sectional survey [J]. Lancet, 2015, 386(10002): 1465-1471.
[20]	Lu R, Mucino-Bermejo MJ, Armignacco P, et al. Survey of acute kidney injury and related risk factors of mortality in hospitalized patients in a third-level urban hospital of Shanghai [J]. Blood Purif, 2014, 38(2): 140-148.
[21]	Broden CC. Acute renal failure and mechanical ventilation: reality or myth? [J]. Crit Care Nurse, 2009, 29(2): 62-75.
[22]	Koyner JL, Murray PT. Mechanical ventilation and lung-kidney interactions [J]. Clin J Am Soc Nephrol, 2008, 3(2): 562-570.
[23]	杨钱华，严玉澄. 急性肺损伤/急性呼吸窘迫综合征相关性急性肾损伤的研究进展[J]. 上海医学，2009, 32(9)：830-833.
[24]	van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis [J]. Crit Care, 2013, 17(3): R98.
[25]	杨俊，顾刘宝，娄青林. 贫血对老年2型糖尿病患者肾功能的影响[J]. 实用老年医学，2015(12)：1025-1027.
[26]	彭丽，王扬天，李洁，等. 贝前列腺素钠对2型糖尿病大鼠肾功能及氧化应激水平的影响[J]. 实用老年医学，2012, 26(3)：200-202.

变量		AKI患者	短暂性AKI	持续性AKI	t/χ²值	P值
例数(%)		652	270 (41.4)	382 (58.6)	?	?
年龄(岁)		87 (84～91)	87 (83.8～91)	87 (84～91)	－0.685	0.400
男性[例(%)]		623 (95.6)	252 (93.3)	371 (97.1)	5.338	0.021
BMI (kg/m²)		23.1±3.2	23.3±3.5	22.9±3.0	1.674	0.149
基础疾病[例(%)]		?	?	?	?	?
?	冠心病	505 (77.5)	205 (75.9)	300 (78.5)	0.616	0.432
?	高血压	485 (74.4)	201 (74.4)	284 (74.3)	0.001	0.977
?	COPD	454 (69.6)	189 (70.0)	265 (69.4)	0.030	0.864
?	糖尿病	234 (35.8)	97 (35.9)	137 (35.9)	0.000	0.987
基础肾功能		?	?	?	?	?
?	Scr (μmol/L)	73.0 (61.0～84.0)	74.0 (63.0～82.0)	72.0 (60.0～85.3)	0.206	0.853
?	eGFR[ml/(min·1.73 m²)]	78.4 (71.2～85.0)	78.4 (72.7～84.5)	78.4 (70.2～85.4)	－0.212	0.840

变量		AKI患者	短暂性AKI	持续性AKI	t/χ²值	P值
例数(%)		652	270 (41.4)	382 (58.6)	?	?
年龄(岁)		87 (84～91)	87 (83.8～91)	87 (84～91)	－0.685	0.400
男性[例(%)]		623 (95.6)	252 (93.3)	371 (97.1)	5.338	0.021
BMI (kg/m²)		23.1±3.2	23.3±3.5	22.9±3.0	1.674	0.149
基础疾病[例(%)]		?	?	?	?	?
?	冠心病	505 (77.5)	205 (75.9)	300 (78.5)	0.616	0.432
?	高血压	485 (74.4)	201 (74.4)	284 (74.3)	0.001	0.977
?	COPD	454 (69.6)	189 (70.0)	265 (69.4)	0.030	0.864
?	糖尿病	234 (35.8)	97 (35.9)	137 (35.9)	0.000	0.987
基础肾功能		?	?	?	?	?
?	Scr (μmol/L)	73.0 (61.0～84.0)	74.0 (63.0～82.0)	72.0 (60.0～85.3)	0.206	0.853
?	eGFR[ml/(min·1.73 m²)]	78.4 (71.2～85.0)	78.4 (72.7～84.5)	78.4 (70.2～85.4)	－0.212	0.840

变量		AKI患者	短暂性AKI	持续性AKI	t/χ²值	P值
例数[例(%)]		652	270 (41.4)	382 (58.6)	?	?
AKI病因[例(%)]		?	?	?	?	?
?	感染	259 (39.7)	100 (37.0)	159 (41.6)	1.389	0.238
?	低血容量	155 (23.8)	55 (20.4)	100 (26.2)	2.944	0.086
?	心血管事件	103 (15.8)	47 (17.4)	56 (14.7)	0.898	0.343
?	肾毒性药物	78 (12.0)	36 (13.3)	42 (11.0)	0.821	0.365
?	手术	45 (6.9)	25 (9.3)	20 (5.2)	3.986	0.046
?	其他	12 (1.8)	7 (2.6)	5 (1.3)	0.820	0.365
AKI发生时伴随情况		?	?	?	?	?
?	平均动脉压(mmHg)	78±14	82±14	76±14	5.543	<0.001
?	少尿[例(%)]	35 (5.4)	6 (2.2)	29 (7.6)	8.978	0.003
?	机械通气[例(%)]	240 (36.8)	53 (19.6)	187 (49.0)	58.478	<0.001
AKI发生时实验室		?	?	?	?	?
?	化验指标	?	?	?	?	?
?	血肌酐(μmol/L)	131.4 (117.5～147.0)	122.0 (111.0～136.0)	138.0 (125.0～156.6)	－6.369	<0.001
?	血肌酐峰值(μmol/L)	143.7 (124.0～200.0)	124.2 (113.5～139.1)	174.3 (140.5～264.9)	－12.688	<0.001
?	尿素氮(mmol/L)	12.6 (8.8～20.9)	10.1 (7.5～14.7)	16.2 (10.0～26.7)	－10.491	<0.001
?	尿酸(μmol/L)	364.9 (290.0～467.0)	338.9 (275.6～421.8)	393.0 (307.2～499.1)	－6.506	<0.001
?	血清前白蛋白(g/L)	181.0 (140.0～231.0)	197 (150～234)	168 (133～230)	3.134	<0.001
?	血清白蛋白(g/L)	34.3±5.5	36.0±5.2	33.1±5.4	6.898	<0.001
?	血镁(mmol/L)	0.9 (0.8～1.0)	0.9 (0.8～1.0)	0.9 (0.8～1.0)	－3.400	0.002
?	血钙(mmol/L)	2.2 (2.1～2.3)	2.2 (2.1～2.3)	2.2 (2.1～2.4)	－0.230	0.905
?	血磷(mmol/L)	1.2 (1.0～1.5)	1.2 (0.9～1.4)	1.2 (1.0～1.5)	－3.008	0.014
?	血红蛋白(g/L)	112±23	119±20	108±23	6.668	<0.001
AKI分期[例(%)]		?	?	?	128.614	<0.001
?	1期	308 (47.2)	190 (70.4)	118 (30.9)	?	?
?	2期	164 (25.2)	63 (23.3)	101 (26.4)	?	?
?	3期	180 (27.6)	17 (6.3)	163 (42.7)	?	?
90 d结局[例(%)]		?	?	?	?	?
?	病死率	219 (33.6)	16 (5.9)	203 (53.1)	158.092	<0.001
?	透析	9 (1.4)	0	9 (2.4)	4.836	0.028

变量		AKI患者	短暂性AKI	持续性AKI	t/χ²值	P值
例数[例(%)]		652	270 (41.4)	382 (58.6)	?	?
AKI病因[例(%)]		?	?	?	?	?
?	感染	259 (39.7)	100 (37.0)	159 (41.6)	1.389	0.238
?	低血容量	155 (23.8)	55 (20.4)	100 (26.2)	2.944	0.086
?	心血管事件	103 (15.8)	47 (17.4)	56 (14.7)	0.898	0.343
?	肾毒性药物	78 (12.0)	36 (13.3)	42 (11.0)	0.821	0.365
?	手术	45 (6.9)	25 (9.3)	20 (5.2)	3.986	0.046
?	其他	12 (1.8)	7 (2.6)	5 (1.3)	0.820	0.365
AKI发生时伴随情况		?	?	?	?	?
?	平均动脉压(mmHg)	78±14	82±14	76±14	5.543	<0.001
?	少尿[例(%)]	35 (5.4)	6 (2.2)	29 (7.6)	8.978	0.003
?	机械通气[例(%)]	240 (36.8)	53 (19.6)	187 (49.0)	58.478	<0.001
AKI发生时实验室		?	?	?	?	?
?	化验指标	?	?	?	?	?
?	血肌酐(μmol/L)	131.4 (117.5～147.0)	122.0 (111.0～136.0)	138.0 (125.0～156.6)	－6.369	<0.001
?	血肌酐峰值(μmol/L)	143.7 (124.0～200.0)	124.2 (113.5～139.1)	174.3 (140.5～264.9)	－12.688	<0.001
?	尿素氮(mmol/L)	12.6 (8.8～20.9)	10.1 (7.5～14.7)	16.2 (10.0～26.7)	－10.491	<0.001
?	尿酸(μmol/L)	364.9 (290.0～467.0)	338.9 (275.6～421.8)	393.0 (307.2～499.1)	－6.506	<0.001
?	血清前白蛋白(g/L)	181.0 (140.0～231.0)	197 (150～234)	168 (133～230)	3.134	<0.001
?	血清白蛋白(g/L)	34.3±5.5	36.0±5.2	33.1±5.4	6.898	<0.001
?	血镁(mmol/L)	0.9 (0.8～1.0)	0.9 (0.8～1.0)	0.9 (0.8～1.0)	－3.400	0.002
?	血钙(mmol/L)	2.2 (2.1～2.3)	2.2 (2.1～2.3)	2.2 (2.1～2.4)	－0.230	0.905
?	血磷(mmol/L)	1.2 (1.0～1.5)	1.2 (0.9～1.4)	1.2 (1.0～1.5)	－3.008	0.014
?	血红蛋白(g/L)	112±23	119±20	108±23	6.668	<0.001
AKI分期[例(%)]		?	?	?	128.614	<0.001
?	1期	308 (47.2)	190 (70.4)	118 (30.9)	?	?
?	2期	164 (25.2)	63 (23.3)	101 (26.4)	?	?
?	3期	180 (27.6)	17 (6.3)	163 (42.7)	?	?
90 d结局[例(%)]		?	?	?	?	?
?	病死率	219 (33.6)	16 (5.9)	203 (53.1)	158.092	<0.001
?	透析	9 (1.4)	0	9 (2.4)	4.836	0.028

危险因素	OR值	95%CI	P值
平均动脉压(mmHg)	0.985	0.971～1.000	0.043
血红蛋白(g/L)	0.989	0.980～0.999	0.025
血肌酐峰值(μmol/L)	1.020	1.015～1.026	<0.001
尿素氮(mmol/L)	1.028	1.000～1.056	0.047
尿酸(μmol/L)	1.002	1.000～1.003	0.040
机械通气(0/1)	1.610	1.012～2.562	0.044

Please choose a citation manager

Content to export