Comparison of outcomes of acute kidney injury in elderly and non-elderly hospitalized patients in a tertiary care hospital in India: a prospective observational study

Devada Sindhu; Gaurav Shekhar Sharma; Minakshi Dhar; Ranjeeta Kumari; Sharon Kandari; Sandeep Saini; Dipesh K. Dhoot; Chandrashekhar Cheluvaiah; Himadri Koley

doi:10.18203/2320-6012.ijrms20240526

Authors

Devada Sindhu Department of Nephrology, AIIMS, Rishikesh, Uttarakhand, India https://orcid.org/0000-0001-8225-6162
Gaurav Shekhar Sharma Department of Nephrology, SGRR Medical college and SMI Hospital, Dehradun, Uttarakhand, India https://orcid.org/0000-0002-4529-9048
Minakshi Dhar Department of Geriatric Medicine, AIIMS Rishikesh, Uttarakhand, India https://orcid.org/0000-0001-6336-5179
Ranjeeta Kumari Department of Community and Family Medicine, AIIMS Rishikesh, Uttarakhand, India
Sharon Kandari Department of Nephrology, AIIMS, Rishikesh, Uttarakhand, India
Sandeep Saini Department of Nephrology, AIIMS, Rishikesh, Uttarakhand, India
Dipesh K. Dhoot Department of Nephrology, AIIMS, Kalyani, Basantapur, West Bengal, India
Chandrashekhar Cheluvaiah Department of Nephrology, AIIMS, Rishikesh, Uttarakhand, India
Himadri Koley Department of Nephrology, Apollo, Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20240526

Keywords:

Elderly, Hemodialysis, ICU, Acute kidney injury, Hospital-acquired AKI, Community-acquired AKI

Abstract

Background: The prevalence of acute kidney injury (AKI) progressively increases with age. A higher rate of dialysis dependency and mortality is observed in elderly with AKI. Here we have studied the comparison of clinical features, outcomes of AKI between elderly (age ³60 years) and non-elderly AKI patients and their risk factors for mortality.

Methods: This prospective observational study enrolled 100 patients with AKI, with elderly and non-elderly in a 1:1 ratio for comparison, from September 2021 to January 2023 at AIIMS Rishikesh in India. Detailed history, clinical examination, relevant laboratory and radiological investigations were done to evaluate for the cause of AKI. Etiological causes, complications of AKI, and in-hospital outcomes were observed. They were given standard treatment and dialysis as per standard indications. We analysed the mortality risk of these groups using the Cox proportional hazards model.

Results: The in-hospital mortality rates among these two groups were non-significant (p=0.29). A significantly higher number of patients with non-elderly AKI were HD-dependent at discharge (p=0.027). Elderly patients had significantly lesser complications like uremic encephalopathy and fluid overload compared to non-elderly. There was a significant association between mortality and female gender, intensive care unit (ICU) admissions, hospital-acquired AKI, pre-renal/renal causes, chronic obstructive pulmonary disease (COPD) as comorbidity, multiple organ dysfunction syndrome (MODS), mechanical ventilation requirement, vasopressor support requirement, need for hemodialysis and prolonged ICU stay.

Conclusions: Elderly patients with AKI do not experience worse mortality outcomes than non-elderly patients with AKI. Therefore, elderly patients should not be denied timely treatment, solely based on their age.

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