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Outcomes of very elderly treated with dialysis for acute kidney injury
. | LitMetric

AI Article Synopsis

  • A study was conducted to identify factors affecting in-hospital mortality in elderly patients (≥ 70 years) suffering from acute kidney injury requiring dialysis (AKI-D).
  • Out of 137 patients, the hospital mortality rate was an alarming 66%, with significant predictors of mortality including altered mental status and the need for mechanical ventilation.
  • The findings suggest that the severity of acute illness plays a crucial role in determining outcomes, indicating that decisions about dialysis should take prognosis and quality of life into account, rather than age alone.

Article Abstract

Background: The factors that determine prognosis in elderly patients with dialysis-requiring acute kidney injury (AKI-D) is uncertain. The purpose of this study was to examine predictors of in-hospital mortality in these patients.

Materials And Methods: A retrospective, single-center study of hospitalized patients ≥ 70 years old with AKI-D. Clinical and demographic variables were compared between survivors and non-survivors, independent predictors of hospital mortality were identified by logistic regression.

Results: Among 137 eligible patients, hospital mortality was 66%; 59% of survivors were dialysis dependent at hospital discharge and 43% of initial survivors died within 1 year post discharge. There was no significant difference in age between survivors (80.2) and non-survivors (80.5) (p = 0.829). Non-survivors had higher rates of altered mental status (68.2 vs. 22.2%, p < 0.001), hypotension (29.5 vs. 13.6%, p = 0.048), leucopenia/leukocytosis (62.6 vs. 42.2%, p = 0.024), ICU admission (59.3 vs. 34.8%, p = 0.007), mechanical ventilation (64 vs. 21.7% p < 0.001), hepatic dysfunction (46.2 vs. 21.7%, p = 0.005), a diagnosis of sepsis (64.8 vs. 26.3%, p = 0.04), and treatment with vasopressors (69.8 vs. 35.6%, p < 0.001). The presence of ≥ 5 of these conditions was associated with > 90% mortality. Logistic regression showed altered mental status (OR = 7.4, 95% CI = 3.0 - 18.2) and mechanical ventilation (OR = 6.0; 95% CI = 2.5 - 14.6, p < 0.001) to independently predict hospital mortality.

Conclusion: Elderly patients with AKI-D have a very high rate of hospital mortality or dialysis-dependent survival. Acute illness severity predicts poor outcome despite dialysis. The decision to dialyze patients in this setting should not be based on age alone but consider prognosis and expected quality of life.
.

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Source
http://dx.doi.org/10.5414/CN109385DOI Listing

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