Li Qinglin, Zhao Meng, Wang Xiaodan
Department of Geriatric Nephrology.
Department of Clinical Data Repository, Chinese PLA General Hospital, Beijing, People's Republic of China.
Clin Interv Aging. 2017 Jun 28;12:1013-1020. doi: 10.2147/CIA.S135241. eCollection 2017.
Acute kidney injury (AKI) is a common complication in elderly patients and is associated with poor outcomes. However, the effect of transient and persistent geriatric AKI on short-term mortality is unclear. We aimed to study the incidence, clinical characteristics, and prognostic impact of transient and persistent AKI in such patients.
We retrospectively enrolled very elderly patients (≥75 years) from the geriatric department of the Chinese PLA General Hospital between 2007 and 2015. AKI was defined according to the 2012 Kidney Disease: Improving Global Outcomes criteria. AKI patients were divided into transient or persistent AKI groups based on their renal function at 3 days post-AKI. Renal function recovery was defined as a return to the baseline serum creatinine (SCr) levels.
In total, 668 geriatric patients (39.0%) experienced AKI, and 652 satisfied the inclusion criteria. Of these 652 patients, 270 (41.4%) had transient AKI, and 382 (58.6%) had persistent AKI. The 90-day mortality was 5.9% in patients with transient AKI and 53.1% in patients with persistent AKI. Multivariate analysis revealed that low hemoglobin levels (odds ratio [OR] =0.989; 95% CI: 0.980-0.999; =0.025), low mean aortic pressure (OR =0.985; 95% CI: 0.971-1.000; =0.043), peak SCr (OR =1.020; 95% CI: 1.015-1.026; <0.001) levels, high uric acid (OR =1.002; 95% CI: 1.000-1.003; =0.040) levels, high blood urea nitrogen (OR =1.028; 95% CI: 1.000-1.056; =0.047) levels, and mechanical ventilation requirements (OR =1.610; 95% CI: 1.012-2.562; =0.044) were associated with persistent AKI. Persistent AKI (hazard ratio [HR] =5.741; 95% CI: 3.356-9.822; <0.001) and more severe AKI stages (stage 2: HR =3.363; 95% CI: 1.973-5.732; <0.001 and stage 3: HR =4.741; 95% CI: 2.807-8.008; <0.001) were associated with 90-day mortality.
AKI is common in very elderly patients, with transient renal injury representing close to 42% of all cases of geriatric AKI. More frequent SCr measurements may be helpful for the early diagnosis of transient geriatric AKI. Persistent geriatric AKI is independently associated with a significantly higher risk of 90-day mortality.
急性肾损伤（AKI）是老年患者常见的并发症，且与不良预后相关。然而，短暂性和持续性老年AKI对短期死亡率的影响尚不清楚。我们旨在研究此类患者中短暂性和持续性AKI的发病率、临床特征及预后影响。
我们回顾性纳入了2007年至2015年期间中国人民解放军总医院老年科的高龄患者（≥75岁）。AKI根据2012年改善全球肾脏病预后组织（KDIGO）标准进行定义。AKI患者根据AKI后3天的肾功能分为短暂性或持续性AKI组。肾功能恢复定义为血清肌酐（SCr）水平恢复至基线。
共有668例老年患者（39.0%）发生AKI，652例符合纳入标准。在这652例患者中，270例（41.4%）为短暂性AKI，382例（58.6%）为持续性AKI。短暂性AKI患者的90天死亡率为5.9%，持续性AKI患者为53.1%。多因素分析显示，低血红蛋白水平（比值比[OR]=0.989；95%置信区间：0.980 - 0.999；P=0.025）、低平均主动脉压（OR =0.985；95%置信区间：0.971 - 1.000；P=0.043）、SCr峰值（OR =1.020；95%置信区间：1.015 - 1.026；P<0.001）水平、高尿酸（OR =1.002；95%置信区间：1.000 - 1.003；P=0.040）水平、高血尿素氮（OR =1.028；95%置信区间：1.000 - 1.056；P=0.047）水平及机械通气需求（OR =1.610；95%置信区间：1.012 - 2.562；P=0.044）与持续性AKI相关。持续性AKI（风险比[HR]=5.741；95%置信区间：3.356 - 9.822；P<0.001）以及更严重的AKI分期（2期：HR =3.363；95%置信区间：1.973 - 5.732；P<0.001和3期：HR =4.741；95%置信区间：2.807 - 8.008；P<0.001）与90天死亡率相关。
AKI在高龄患者中很常见，短暂性肾损伤占老年AKI病例的近42%。更频繁地测量SCr可能有助于早期诊断短暂性老年AKI。持续性老年AKI与90天死亡率显著升高独立相关。
