Mahesh Eshwarappa, Nallamuthu Praveen, Kumar Mahesh, Madhyastha Parampalli Rakesh, Konanna Gurudev
Department of Nephrology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India.
Saudi J Kidney Dis Transpl. 2017 Jul-Aug;28(4):886-890.
The incidence of acute kidney injury (AKI) is high in the elderly, who comprise an ever-growing segment of the population. Elderly patients pose a different set of diagnostic and therapeutic challenge owing to their associated comorbidities. AKI in the elderly is associated with an increased risk of mortality, morbidity, prolonged length of stay, and progression to chronic kidney disease. Data regarding the clinical profile of AKI in the elderly from the South Indian population are limited. Hence, we present this analysis of the etiological and prognostic factors associated with AKI in elderly population from South India. This is a cross-sectional, prospective, observational study conducted in a tertiary care teaching hospital from Bengaluru, during the period from May 2011 to October 2012. Institutional Ethical Committee clearance was obtained. Informed consents were obtained from patients who fulfilled the inclusion criteria. Elderly patients >60 years of age with features of AKI (Risk, Injury, Failure, Loss, and End-stage criteria) 1 at admission and those who developed AKI following hospital admission were included in the study. Demographic details, detailed medical history, comorbid conditions, etiological factors, prognostic factors, and outcomes were collected. Statistical analysis was done using Statistical Package for the Social Sciences software. Two hundred patients fulfilled the inclusion criteria and were enrolled into the study. The mean age was 70.5 years. Fifty-nine percent were males and 41% were females. Peak incidence of AKI was in the age group 60-69 years. Diabetes was seen in 44%, hypertension in 35%, ischemic heart disease in 19%, and chronic obstructive pulmonary disease in 12% of cases. Ninety-one percent had AKI at admission, and the rest developed it during hospitalization. The average duration of hospital stay was seven days. Etiological factors for AKI were medical in 87% of the cases, surgical in 11%, and gynecological in 2%. Sepsis was the most common etiology of AKI among the medical cases. Among sepsis, pneumonia and urosepsis were the most common causes of AKI. Medical AKI had a better outcome compared to surgical causes of AKI. Fifty-six (28%) patients required dialysis. Forty-four patients received hemodialysis and 12 received peritoneal dialysis. The overall mortality in the study group was 15%. Mortality among oliguric AKI (25%) was higher than in nonoliguric AKI (5%) patients (P = 0.002). The mortality rate was higher among postsurgical AKI compared to the medical causes (P <0.001) and in patients who required dialysis. Sepsis is the most common cause of AKI in elderly with high morbidity and mortality. Oliguria, postsurgical AKI, and need for dialysis were independent predictors of mortality.
急性肾损伤（AKI）在老年人中的发病率较高，而老年人群在总人口中所占比例日益增大。由于存在合并症，老年患者面临一系列不同的诊断和治疗挑战。老年患者发生AKI会增加死亡、发病风险，延长住院时间，并增加进展为慢性肾脏病的可能性。来自南印度人群的关于老年患者AKI临床特征的数据有限。因此，我们对南印度老年人群中与AKI相关的病因和预后因素进行了此项分析。这是一项在班加罗尔一家三级护理教学医院进行的横断面、前瞻性观察性研究，研究时间为2011年5月至2012年10月。已获得机构伦理委员会批准。对符合纳入标准的患者均获得了知情同意。纳入研究的患者为入院时具有AKI特征（风险、损伤、衰竭、丧失和终末期标准）1的60岁以上老年患者以及入院后发生AKI的患者。收集了人口统计学细节、详细病史、合并症、病因、预后因素及转归情况。使用社会科学统计软件包进行统计分析。200例患者符合纳入标准并被纳入研究。平均年龄为70.5岁。男性占59%，女性占41%。AKI的发病高峰年龄组为60 - 69岁。44%的病例患有糖尿病，35%患有高血压，19%患有缺血性心脏病，12%患有慢性阻塞性肺疾病。91%的患者入院时即患有AKI，其余患者在住院期间发生。平均住院时间为7天。AKI的病因中，87%为内科病因，11%为外科病因，2%为妇科病因。脓毒症是内科病因中AKI最常见的病因。在脓毒症中，肺炎和尿脓毒症是AKI最常见的病因。与外科病因导致的AKI相比，内科AKI的转归更好。56例（28%）患者需要透析。44例接受血液透析，12例接受腹膜透析。研究组的总死亡率为15%。少尿型AKI患者的死亡率（25%）高于非少尿型AKI患者（5%）（P = 0.002）。外科术后AKI患者的死亡率高于内科病因导致的AKI患者（P <0.001），且需要透析的患者死亡率更高。脓毒症是老年患者AKI最常见的病因，发病率和死亡率均较高。少尿、外科术后AKI以及需要透析是死亡的独立预测因素。
