Service Néphrologie-Dialyse-Aphérèse, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.
Service Médecine Gériatrique, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.
J Nephrol. 2022 Nov;35(8):2097-2108. doi: 10.1007/s40620-022-01322-z. Epub 2022 May 3.
Acute Kidney Injury (AKI) is increasingly common in people over 65 years of age, but its causes and management are poorly described. The purpose of this study was to describe the causes, management and prognosis of patients over 65 hospitalised for severe acute kidney injury (AKI) in all departments of a tertiary centre.
The prospective IRACIBLE (IRA: AKI in French; CIBLE: target in French) cohort included 480 patients hospitalised at a university hospital over 18 months for severe AKI or subgroup of AKIN3 (Acute Kidney Injury Network classification) defined by an acute creatinine increase > 354 μmol/L or managed with acute renal replacement therapy (RRT). The history, aetiology of AKI, management, and prognosis were compared in three age groups: < 65, 65-75, and > 75 years.
The study population included 480 subjects (73% men) with a median body mass index (BMI) of 26.6 kg/m [23.3, 30.9], 176 (37%) diabetic patients, 124 (26%) patients < 65 years, 150 (31%) 65-75 years and 206 (43%) > 75 years. Increasing age class was associated with more comorbidities, a significantly lower median estimated glomerular filtration rate (eGFR) 6 months before inclusion (82; 62; 46 ml/min/1.73 m, p < 0.05) and aetiology of AKI, which was more often obstructive (12%; 15%; 23%, p = 0.03) or part of a cardio-renal syndrome (6%; 9%; /15%, p = 0.04). Older patients were less often managed in the intensive care unit (54%; 47%; 24%, p < 0.0001), were less frequently treated by RRT (52%; 43%; 31%, p < 0.001) and received fewer invasive treatments (6%; 9%; 22%, p < 0.0001). Older survivors returned home less often (80%; 73%; 62%, p = 0.05) in favour of transfers to rehabilitation services (10%; 13%; 22%) with higher mortality at 3 months (35%; 32%; 50%, p < 0.0001).
Older patients hospitalised for severe AKI have a specific profile with more comorbidities, lower baseline renal function, an aetiology of AKI of mainly extra-parenchymal causes and a complex pathway of care with an overall poor prognosis.
急性肾损伤（AKI）在 65 岁以上人群中越来越常见，但对其病因和治疗的描述仍不够完善。本研究的目的是描述所有科室中因严重急性肾损伤（AKI）住院的 65 岁以上患者的病因、治疗和预后。
前瞻性的 IRACIBLE（IRA：法语中的 AKI；CIBLE：法语中的目标）队列纳入了 480 名在大学医院住院的患者，这些患者在 18 个月内因严重 AKI 或 AKIN3 亚组（急性肾损伤网络分类）住院，AKIN3 的定义为急性肌酐增加 > 354 μmol/L 或接受急性肾脏替代治疗（RRT）治疗。比较了三组年龄的患者（< 65 岁、65-75 岁和> 75 岁）的病史、AKI 的病因、治疗和预后。
该研究人群包括 480 名患者（73%为男性），平均体重指数（BMI）为 26.6 kg/m[23.3, 30.9]，176 名（37%）为糖尿病患者，124 名（26%）为< 65 岁患者，150 名（31%）为 65-75 岁患者，206 名（43%）为> 75 岁患者。随着年龄的增加，患者的合并症更多，6 个月前估算肾小球滤过率（eGFR）中位数显著降低（82；62；46 ml/min/1.73 m，p<0.05），AKI 的病因也更多为梗阻性（12%；15%；23%，p=0.03）或为心肾综合征的一部分（6%；9%；/15%，p=0.04）。年龄较大的患者较少入住重症监护病房（54%；47%；24%，p<0.0001），较少接受 RRT 治疗（52%；43%；31%，p<0.001），较少接受有创治疗（6%；9%；22%，p<0.0001）。年龄较大的幸存者较少能返回家中（80%；73%；62%，p=0.05），更多的患者被转移到康复服务机构（10%；13%；22%），3 个月时死亡率更高（35%；32%；50%，p<0.0001）。
因严重 AKI 住院的老年患者具有特定的特征，合并症更多，基线肾功能更低，AKI 的病因主要为肾外原因，治疗途径复杂，总体预后较差。
