Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou 510080, People's Republic of China.
Clin Interv Aging. 2021 Jan 7;16:35-42. doi: 10.2147/CIA.S286660. eCollection 2021.
Acute kidney injury (AKI) is a major health problem with poor prognosis. However, little is known about elderly community-acquired-AKI (CA-AKI). This study aimed to investigate the incidence, clinical characteristics, outcomes and use of suspected nephrotoxic medications after CA-AKI in the elderly.
A total of 36,445 patients aged over 60 years were recruited from 2013 to 2016. Through an electronic database, we collected the demographic and medical history data, and admission lab results from all patients.
A total of 2371 patients with CA-AKI were identified. The incidence of CA-AKI was 26.03% in the elderly. The proportion of CA-AKI patients with chronic comorbidities and Charlson comorbidity index score were higher than that of non-AKI patients. After CA-AKI, the proportions of exposure to non-steroidal anti-inflammatory drugs (NSAIDs), iodine contrast agent, angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) were significantly decreased (p < 0.001). However, the proportion of other possible nephrotoxic drugs (including aminoglycosides, glycopeptide antibiotics, antifungal agents, beta lactam antibiotics, diuretic, ferralia, adrenergic receptor agonists and drugs for cardiac insufficiency therapy) still increased after CA-AKI (p < 0.001). Compared with non-AKI patients, CA-AKI patients had higher percentage of cardiogenic shock, multiple organ failure, transferring to intensive care unit, cardio-pulmonary resuscitation, hemodialysis, and mortality (p < 0.001). Moreover, CA-AKI patients had worse prognosis when more kinds of suspected nephrotoxic drugs were used (p < 0.001).
The incidence of CA-AKI in the elderly was high, with more complex chronic complications and poor clinical outcomes. The use of most suspected nephrotoxic drugs still increased and was associated with worse prognosis after CA-AKI.
急性肾损伤（AKI）是一种预后不良的主要健康问题。然而，对于老年社区获得性 AKI（CA-AKI）知之甚少。本研究旨在调查老年 CA-AKI 后的发病率、临床特征、结局和疑似肾毒性药物的使用情况。
2013 年至 2016 年期间，共招募了 36445 名年龄在 60 岁以上的患者。通过电子数据库，我们收集了所有患者的人口统计学和病史数据以及入院实验室结果。
共确定了 2371 例 CA-AKI 患者。老年人 CA-AKI 的发病率为 26.03%。患有慢性合并症和 Charlson 合并症指数评分的 CA-AKI 患者比例高于非 AKI 患者。在 CA-AKI 后，非甾体抗炎药（NSAIDs）、碘造影剂、血管紧张素转换酶抑制剂（ACEI）或血管紧张素 II 受体阻滞剂（ARB）的暴露比例显着降低（p < 0.001）。然而，其他可能的肾毒性药物（包括氨基糖苷类、糖肽类抗生素、抗真菌药物、β内酰胺类抗生素、利尿剂、铁剂、肾上腺素受体激动剂和心力衰竭治疗药物）的比例在 CA-AKI 后仍增加（p < 0.001）。与非 AKI 患者相比，CA-AKI 患者心源性休克、多器官衰竭、转入重症监护病房、心肺复苏、血液透析和死亡率的百分比更高（p < 0.001）。此外，CA-AKI 患者使用的疑似肾毒性药物种类越多，预后越差（p < 0.001）。
老年人 CA-AKI 的发病率较高，伴有更复杂的慢性并发症和较差的临床结局。在 CA-AKI 后，大多数疑似肾毒性药物的使用仍在增加，并与预后不良相关。
