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Dias RPL, Duarte DB, Barbosa DDCBM, Campos RP. Acute kidney injury in nonagenarians: clinical characteristics and mortality. J Bras Nefrol 2024; 46:e20230088. [PMID: 38788055 DOI: 10.1590/2175-8239-jbn-2023-0088en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/16/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. METHODS Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. RESULTS A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality. CONCLUSION AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.
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Affiliation(s)
| | - Daniella Bezerra Duarte
- Centro Universitário Tiradentes, Faculdade de Medicina, Maceió, AL, Brazil
- Universidade Federal de Alagoas, Faculdade de Medicina, Maceió, AL, Brazil
- Santa Casa de Misericórdia de Maceió, Instituto de Nefrologia Ribamar Vaz, Maceió, AL, Brazil
| | | | - Rodrigo Peixoto Campos
- Universidade Federal de Alagoas, Faculdade de Medicina, Maceió, AL, Brazil
- Santa Casa de Misericórdia de Maceió, Instituto de Nefrologia Ribamar Vaz, Maceió, AL, Brazil
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Veizi BGY, Taşcı İ, Naharci MI. Geriatric syndromes in the population older than 90 years: The prevalence and association with chronic diseases. Australas J Ageing 2023; 42:472-479. [PMID: 37161641 DOI: 10.1111/ajag.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The aim of this study was to explore the prevalence of geriatric syndromes and comorbid conditions, as well as their interrelationships, in individuals aged 90 years and over. METHODS This study included participants aged 90 years and older who underwent a comprehensive geriatric assessment in a tertiary geriatric outpatient clinic. Demographic and clinical characteristics were obtained using the electronic medical records. The geriatric syndrome burden was calculated by adding each syndrome, which was then stratified into one of two groups based on the median value: no or low burden (<4) and high burden (≥4). The modified Charlson comorbidity index was used to determine chronic disease burden. RESULTS A total of 235 participants (93.2 ± 2.7 years) were recruited in this study. The mean index score was 7.3, and 46% (n = 107) of participants had a high geriatric syndrome burden. The most common geriatric syndrome was incontinence (69%), followed by polypharmacy (60%) and depression (43%). When compared to patients without such a diagnosis, the prevalence of polypharmacy was significantly higher in patients diagnosed with hypertension, chronic kidney disease, cardiovascular disease, diabetes mellitus and chronic obstructive pulmonary disease (p = 0.02, p = 0.02, p < 0.001, p = 0.008, p = 0.007, respectively). However, no chronic disease was associated with geriatric syndrome burden. CONCLUSIONS We found that the burden of medical conditions in the older population over 90 years of age could influence general health status significantly, with a high prevalence of chronic diseases and geriatric syndromes.
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Affiliation(s)
- Betül Gülsüm Yavuz Veizi
- Department of Geriatrics, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - İlker Taşcı
- Department of Internal Medicine, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Ilkin Naharci
- Department of Geriatrics, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Chokshi NBK, Karmakar B, Pathan SK, Joshi V, Gohel DM, Coulshed DS, Negishi K, Pathan FK. A Systematic Review of Frailty Scores Used in Heart Failure Patients. Heart Lung Circ 2023; 32:441-453. [PMID: 36804767 DOI: 10.1016/j.hlc.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Frailty is a complex, multi-dimensional syndrome commonly observed in patients with heart failure (HF). The presence of frailty in patients living with HF is strongly associated with increased vulnerability to adverse events, including falls, hospitalisation, and increased mortality. Several scoring systems have been developed to assess the presence of frailty in patients with HF. These scoring systems vary in their complexity and applicability; however, they provide the physician with a more comprehensive understanding of the biological, functional, and psycho-social needs of these patients. OBJECTIVES To assess the clinical applicability of frailty tools in HF patients and their prognostic value, specifically relating to outcomes such as mortality, readmissions, and clinical deterioration. METHODS A literature search using six electronic databases (PubMed, Scopus, Embase, Medline, Cochrane and Web of Science) was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Key search Medical Subject Headings (MeSH) terms combined "Frailty" AND "Heart failure". Studies were included if they assessed frailty using systematically defined criteria in a HF population. The PRISMA guidelines were used to include all relevant articles based on titles and abstracts. Full text articles were screened based on abstract relevance. A systematic narrative review of the literature was conducted on the final list of full text articles. RESULTS An initial search yielded 8,066 articles. Following the removal of duplicates, title, and abstract searches, the remaining 154 articles underwent full text review, with 31 articles accepted for final qualitative synthesis. The two most utilised frailty scores were the Fried Frailty Phenotype (n=10) and the Barthel Index (n=8). The frailty scores provide prognostic data on multiple outcomes including mortality, increased hospitalisation, and functional decline. CONCLUSION At the present time there is no universally applied frailty measure in a HF population. Choice of frailty score should be guided by physician experience and clinical setting, as well as tailored to a patient's functional, biological, and psycho-social circumstances. A push to adopt a single universal scoring system may help to ensure that frailty is assessed in all patients who live with HF.
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Affiliation(s)
- Niraliben B K Chokshi
- Charles Perkins Centre, Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Bratati Karmakar
- Charles Perkins Centre, Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Shahab K Pathan
- Cardiology Department, Concord Hospital, Sydney, NSW, Australia
| | - Vikram Joshi
- Rehabilitation Department, Nepean Hospital, Sydney, NSW, Australia
| | - Dhwani M Gohel
- Charles Perkins Centre, Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - David S Coulshed
- Charles Perkins Centre, Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia; Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
| | - Kazuaki Negishi
- Charles Perkins Centre, Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia; Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
| | - Faraz K Pathan
- Charles Perkins Centre, Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia; Cardiology Department, Nepean Hospital, Sydney, NSW, Australia.
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Stille K, Kribben A, Herget-Rosenthal S. Incidence, severity, risk factors and outcomes of acute kidney injury in older adults: systematic review and meta-analysis. J Nephrol 2022; 35:2237-2250. [PMID: 35932418 DOI: 10.1007/s40620-022-01381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Old age was identified as a strong risk factor for acute kidney injury (AKI). Our objectives were to provide estimates of AKI, risk factors and outcomes in patients ≥ 75 years for whom data are scarce. METHODS Observational studies and randomized controlled trials between 2005 and 2021 with patients of mean or median age ≥ 75 years, reporting AKI according to current definitions. Data on AKI incidence, risk factors and mortality were analyzed separately in unselected (UC) and acute heart failure (AHF) cohorts. RESULTS Twenty-six observational studies and 4 randomized controlled trials with 51,111 UC and 25,414 AHF patients were included. Ages averaged 79.4 and 79.8 years, respectively. Pooled risk ratios (RRs) of AKI rates were 26.29% (95% confidence intervals (CI) 13.20-41.97) (UC) and 24.21% (95% CI 20.03-28.65) (AHF). In both cohorts, AKI was associated with decreased estimated glomerular filtration rate at baseline, chronic kidney disease (UC: RR 1.80 (95% CI 1.15-2.80), AHF: RR 1.51 (95% CI 1.26-1.95) and hypertension (UC: RR 1.30 (95% CI 1.09-1.56), AHF: RR 1.07 (95% CI 1.05-1.09). RRs of AKI in patients on renin-angiotensin-inhibitors were 0.87 (95% CI 0.78-0.97) and 0.88 (95% CI 0.78-0.98) in UC and AHF, respectively. AKI was consistently associated with increased risk of in-hospital mortality (UC: RR 3.15 (95% CI 2.28-4.35), AHF: RR 4.28 (95% CI 2.53-7.24). CONCLUSION AKI is frequent in patients ≥ 75 years. While reduced renal function at baseline, CKD and hypertension were associated with AKI development, renin-angiotensin-inhibitors may be protective. Older AKI patients showed higher short-term mortality rates.
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Affiliation(s)
- Kolja Stille
- Department of Medicine, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199, Bremen, Germany
| | - Andreas Kribben
- Department of Nephrology, Universitätsklinikum, Universität Duisburg-Essen, Essen, Germany
| | - Stefan Herget-Rosenthal
- Department of Medicine, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199, Bremen, Germany. .,Department of Nephrology, Universitätsklinikum, Universität Duisburg-Essen, Essen, Germany.
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Santos B, Sanz M, Muñoz Ramos P, Gilabert N, Costa R, Otero S, Carles P, Ruano P, Quiroga B. [Baseline characteristics of nonagenarians hospitalised due to acute kidney injury compared to other age groups]. Rev Esp Geriatr Gerontol 2020; 55:326-331. [PMID: 32718579 DOI: 10.1016/j.regg.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/07/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The increase in life expectancy leads to higher hospitalisation rates in elderly patients. The aim of this work is to study the characteristics of the population over 90 years of age that are admitted due to acute kidney injury (AKI). MATERIAL AND METHODS A cross-sectional study was conducted that included all patients admitted to hospital with AKI in the years 2013 and 2014. Epidemiological characteristics, comorbidity, medication and baseline analytical data were collected, and a comparison was made between patients with age over 90 years-old and the others. RESULTS A total of 1733 patients were included, of whom 264 (15%) were over 90 years-old. A significantly higher proportion of these patients were women. The most frequent cause of AKI in patients older than 90 years was functional (81%) (p < 0.001 compared to other age groups). The main cause of hospital admission was infection. In the group of over 90 years of age, a higher prevalence was found for arterial hypertension (p = 0.005), chronic kidney disease (p = 0.014), congestive heart failure (p = 0.006), and cognitive impairment (p < 0.0001). The baseline glomerular filtration rate by CKD-EPI was lower in the group of patients older than 90 years (p < 0.0001). Patients under 90 years admitted to hospital due to AKI, had a higher prevalence of diabetes mellitus (p < 0.001), dyslipidaemia (p < 0.001), history of neoplasia (p < 0.001), and a higher Barthel index (p < 0.0001). CONCLUSIONS Nonagenarians admitted due to AKI have functional aetiology as the most common factor. These patients have a higher prevalence of hypertension, heart failure, chronic kidney disease, low functional status, and more cognitive impairment.
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Affiliation(s)
- Begoña Santos
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España
| | - Marta Sanz
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España
| | | | - Noemi Gilabert
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - Ramón Costa
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - Silvia Otero
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - Patricia Carles
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - Pablo Ruano
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España.
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Sousa ALB, de Souza LM, Santana Filho OV, E Léda VHF, Rocha PN. Incidence, predictors and prognosis of acute kidney injury in nonagenarians: an in-hospital cohort study. BMC Nephrol 2020; 21:34. [PMID: 32000715 PMCID: PMC6993395 DOI: 10.1186/s12882-020-1698-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background Given the aging of the population, nephrologists are ever more frequently assisting nonagenarians with acute kidney injury (AKI). The management of these patients presents unique characteristics, including bioethical dilemmas, such as the utilization of renal replacement therapy (RRT) at this extreme age. Methods We conducted a retrospective cohort study at a tertiary hospital. Over a 10-year period, 832 nonagenarians were hospitalized for two or more days. A random sample of 461 patients was obtained; 25 subjects were excluded due to lack of essential data. AKI was defined and staged according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results We analyzed data from 436 patients, mean age 93.5 ± 3.3 years, 74.3% female; 76.4% required intensive care unit (ICU). The incidence of AKI was 45%. Length of hospital stay, ICU admission, vasopressors, and mechanical ventilation (MV) were independent predictors of AKI. Overall in-hospital mortality was 43.1%. Mortality was higher in the AKI compared to the no AKI group (66.8% vs. 23.8%, p < 0.001). Only 13 patients underwent RRT; all were critically ill, requiring vasopressors and 76.9% in MV. Mortality for this RRT group was 100% but not significantly higher than that observed in 26 non-RRT controls (96.1%, p = 1.0) obtained by proportional random sampling, matched by variables related to illness severity. In multivariable analysis, age, Charlson’s score, vasopressors, MV, and AKI – but not RRT – were independent predictors of mortality. Conclusions AKI is common in hospitalized nonagenarians and carries a grave prognosis, especially in those who are critically iil. The use of RRT was not able to change the fatal prognosis of this subgroup of patients. Our data may help guide informed decisions about the utility of RRT in this scenario.
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Affiliation(s)
- Andre Luis Bastos Sousa
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil.
| | - Leticia Mascarenhas de Souza
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil
| | - Osvaldino Vieira Santana Filho
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil
| | - Victor Hugo Ferreira E Léda
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil
| | - Paulo Novis Rocha
- Medical School of Bahia of the Federal University of Bahia, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA, 40110-100, Brazil
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Huang W, Sun Y, Xing Y, Wang C. Functional impairment and serum albumin predict in-hospital mortality in nonagenarians with acute infection: a retrospective cohort study. BMC Geriatr 2019; 19:269. [PMID: 31615427 PMCID: PMC6794842 DOI: 10.1186/s12877-019-1301-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 09/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background Acute infection leads to substantial mortality in the nonagenarian population. However, the predictive efficacies of functional status and biochemical indexes for in-hospital mortality in these patients remain to be determined. Methods A single-center, retrospective cohort study was performed. Consecutive nonagenarian patients who were admitted to our department from January 1, 2014 to December 31, 2016 for acute infectious diseases were included. Baseline data for medical history, functional status, and biochemical indexes were obtained on admission. The outcomes of these patients during hospitalization were recorded. Predictors of in-hospital mortality were identified via logistic regression analyses. Results A total of 162 patients were included, and 46 patients died (17.2%) during hospitalization. Univariate analysis showed that the prevalence rates of atrial fibrillation (32.1%) and malignant disease (26.5%) were higher in nonagenarian patients who died during hospitalization than in those who discharged. Multivariate logistic regression analyses identified malignant disease (odds ratio [OR] 2.73, 95% confidence interval [CI]: 1.10–6.78), ADL category (OR 0.82, 95% CI: 0.75–0.89) and serum albumin (OR 0.86, 95%CI 0.78–0.95) as independent predictors of in-hospital mortality in nonagenarian patients hospitalized for acute infection. Conclusions Functional impairment as well as serum albumin may be independent predictors of in-hospital mortality in nonagenarian patients hospitalized for acute infectious diseases. Stratification of patients according to Barthel Index score and serum albumin is very necessary.
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Affiliation(s)
- Wei Huang
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China
| | - Ying Sun
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China.
| | - Yunli Xing
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China
| | - Cuiying Wang
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China
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Alshelleh SA, Oweis AO, Alzoubi KH. Acute kidney injury among nonagenarians in Jordan: a retrospective case-control study. Int J Nephrol Renovasc Dis 2018; 11:337-342. [PMID: 30555251 PMCID: PMC6280911 DOI: 10.2147/ijnrd.s186121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Improvements in health care systems worldwide have had notable effects on the life expectancy of older individuals. As a result, nonagenarians are emerging as a separate age group with distinct health care needs. The aim of this study was to evaluate the incidence of acute kidney injury (AKI), the mortality rates, and length of in-hospital stay among nonagenarians. Methods This is a retrospective case–control chart review of patients of age 90 years and above who were admitted to hospital. Patients with Stage I, II, or III chronic kidney disease were included in the analysis. The incidence of AKI was determined using data from the Acute Kidney Injury Network (AKIN) classification. Primary outcome variables included length of in-hospital stay and mortality rates. Results Of the 253 patients who were included in the study, the mean age was 91.5 years, 61 of the patients (25.9%) developed AKI, and 41 patients (66.1%) were in Stage I AKI according to AKIN criteria. Fifty-seven patients died during the study period; 57.9% of those patients had AKI. Hospital stay was longer in patients with AKI with a mean length of stay of 8.1 days. Congestive heart failure, cancer, and use of non-steroidal anti-inflammatory drugs were the main risk factors for AKI among those patients. Conclusion AKI is common in nonagenarians. It was associated with increased length of hospital stays and increased risk for mortality.
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Affiliation(s)
- Sameeha A Alshelleh
- Division of Nephrology, Department of Medicine, The University of Jordan, Amman, Jordan,
| | - Ashraf O Oweis
- Division of Nephrology, Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Spannella F, Giulietti F, Balietti P, Cocci G, Landi L, Lombardi FE, Borioni E, Bernardi B, Rosettani G, Bordoni V, Sarzani R. Renin-Angiotensin System Blockers and Statins Are Associated With Lower In-Hospital Mortality in Very Elderly Hypertensives. J Am Med Dir Assoc 2017; 19:342-347. [PMID: 29128438 DOI: 10.1016/j.jamda.2017.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/22/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Cardiovascular diseases are mainly related to hypertension and dyslipidemia and increase with aging because of the larger time span for these risk factors to damage arterial blood vessels. The impact of cardiovascular drug therapy on outcomes in the very elderly hospitalized is still not well established. The aim of our study was to evaluate the associations between cardiovascular therapy and in-hospital mortality in very elderly hypertensives. DESIGN Prospective observational study. SETTING Hospital assessment. PARTICIPANTS 310 very elderly hypertensive patients admitted to our Internal Medicine and Geriatrics Department for medical conditions. MEASUREMENTS Main comorbidities, laboratory parameters, and cardiovascular drug therapy taken before admission were considered for the analyses. RESULTS The mean age was 88.1 ± 5.1 years, with female prevalence of 57.4%. Among cardiovascular drugs taken before admission, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and statins were those associated with lower in-hospital mortality, even after adjusting for covariates (age, hemoglobin, albumin, acute kidney injury, ADL Hierarchy Scale, NT-proBNP levels) [odds ratio (OR) = 0.46, P = .045, and OR = 0.21, P = .008, respectively]. No difference regarding in-hospital mortality was found between ACE inhibitors and angiotensin receptor blockers (P = .414). CONCLUSION ACE inhibitors/angiotensin receptor blockers and statins, through their beneficial effects on the cardiovascular system, have a positive impact on survival in very elderly hospitalized patients. Our data confirm the important role of such drugs even in this particular population with a mean age higher than 88 years, where scientific evidence is still scanty.
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Affiliation(s)
- Francesco Spannella
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Paolo Balietti
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Guido Cocci
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Laura Landi
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Francesca Elena Lombardi
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Elisabetta Borioni
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Beatrice Bernardi
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Giulia Rosettani
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Valentina Bordoni
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy.
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Chao CT, Tsai HB, Chiang CK, Huang JW, Hung KY. Acute kidney injury as a risk factor for diagnostic discrepancy among geriatric patients: a pilot study. Sci Rep 2016; 6:38549. [PMID: 27982065 PMCID: PMC5159791 DOI: 10.1038/srep38549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/09/2016] [Indexed: 01/22/2023] Open
Abstract
Diagnostic discrepancy, defined as different admission and discharge diagnoses, could be a potential source of diagnostic error. We evaluated whether acute kidney injury (AKI) in the elderly affected their risk for diagnostic discrepancy. Patients aged ≥60 years from the general medical wards were prospectively enrolled and divided according to AKI status upon admission, using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We compared their discharge and admission diagnoses and identified patients with a diagnostic discrepancy, using multiple logistic regression analysis to evaluate the relationship between initial AKI and the presence of a diagnostic discrepancy. A total of 188 participants (mean age, 77.9 years) were recruited. Regression analysis showed that initial AKI on admission was associated with a higher risk of diagnostic discrepancy upon discharge (odds ratio [OR] 3.3; p < 0.01). In contrast, higher AKI severity was also associated with an increased risk of diagnostic discrepancy (for KDIGO grade 1, 2, and 3; OR 2.92, 3.91, and 4.32; p = 0.04, 0.03, and 0.02, respectively), suggesting that initial AKI upon admission could be an important risk factor for diagnostic discrepancy. Consequently, reducing geriatric AKI might have the potential to reduce diagnostic discrepancy among these patients.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital Jinshan branch, New Taipei City, Taiwan.,Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Bin Tsai
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Kang Chiang
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Integrative Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenq-Wen Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yu Hung
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu County, Taiwan
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Chao CT, Tsai HB, Wu CY, Hsu NC, Lin YF, Chen JS, Hung KY. Cross-sectional study of the association between functional status and acute kidney injury in geriatric patients. BMC Nephrol 2015; 16:186. [PMID: 26552371 PMCID: PMC4640369 DOI: 10.1186/s12882-015-0181-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 10/31/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease tend to have impaired functional status, and this can increase the risk of morbidity and mortality. However, no previous studies have rigorously evaluated the relationship between incident acute kidney injury (AKI) and functional status of elderly patients. METHODS Elderly patients (≥ 65 years-old) were prospectively from the general medical wards of a single medical center in Taiwan between January, 2014 and August, 2014. These patients were divided into those with and without AKI at initial presentation, according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Functional status was assessed by Barthel Index on admission. Multiple regression analyses were utilized to investigate the relationship between AKI and functional status. RESULTS One hundred and fifty-two elderly patients were recruited, 38.9 % of whom had AKI. Patients with AKI at admission had significantly higher mean Charlson Comorbidity Index score (p = 0.05) and borderline lower mean Barthel Index score (34.5 vs. 43.1; p = 0.08), and a significantly lower bladder continence subscale (5.4 vs. 7.0; p = 0.05). Multiple regression analyses indicated that the presence of AKI at admission was associated with a significantly lower Barthel Index score (p = 0.04). Increasing AKI severity (higher KDIGO stage) was also associated with significantly lower Barthel Index score (p < 0.01). CONCLUSIONS This study documented a close relationship between AKI and functional status in the elderly. Interventions that aim to restore functional status might help to lower the risk of AKI in the elderly.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital Jin-Shan branch, NO.51, Nan-shih, Jin-shan district, New Taipei City, 208, Taiwan.
| | - Hung-Bin Tsai
- Department of Traumatology, National Taiwan University Hospital, NO.7 Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Chia-Yi Wu
- Graduate Institute of Nursing, National Taiwan University, Taipei, Taiwan.
| | - Nin-Chieh Hsu
- Department of Traumatology, National Taiwan University Hospital, NO.7 Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Yu-Feng Lin
- Department of Traumatology, National Taiwan University Hospital, NO.7 Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Jin-Shing Chen
- Department of Traumatology, National Taiwan University Hospital, NO.7 Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Kuan-Yu Hung
- Department of Internal Medicine, National Taiwan University Hospital, NO.7 Chung-Shan South Road, Taipei, 100, Taiwan.
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Chao CT, Tsai HB, Wu CY, Lin YF, Hsu NC, Chen JS, Hung KY. The severity of initial acute kidney injury at admission of geriatric patients significantly correlates with subsequent in-hospital complications. Sci Rep 2015; 5:13925. [PMID: 26355041 PMCID: PMC4564739 DOI: 10.1038/srep13925] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/11/2015] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury (AKI) is associated with higher hospital mortality. However, the relationship between geriatric AKI and in-hospital complications is unclear. We prospectively enrolled elderly patients (≥65 years) from general medical wards of National Taiwan University Hospital, part of whom presented AKI at admission. We recorded subsequent in-hospital complications, including catastrophic events, incident gastrointestinal bleeding, hospital-associated infections, and new-onset electrolyte imbalances. Regression analyses were utilized to assess the associations between in-hospital complications and the initial AKI severity. A total of 163 elderly were recruited, with 39% presenting AKI (stage 1: 52%, stage 2: 23%, stage 3: 25%). The incidence of any in-hospital complication was significantly higher in the AKI group than in the non-AKI group (91% vs. 68%, p < 0.01). Multiple regression analyses indicated that elderly patients presenting with AKI had significantly higher risk of developing any complication (Odds ratio [OR] = 3.51, p = 0.01) and new-onset electrolyte imbalance (OR = 7.1, p < 0.01), and a trend toward more hospital-associated infections (OR = 1.99, p = 0.08). The risk of developing complications increased with higher AKI stage. In summary, our results indicate that initial AKI at admission in geriatric patients significantly increased the risk of in-hospital complications.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital Jin-Shan branch, New Taipei City, Taiwan
- Graduate Institute of Toxicology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Bin Tsai
- Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Yi Wu
- The Department of Nursing, National Taiwan University, Taipei, Taiwan
| | - Yu-Feng Lin
- Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Nin-Chieh Hsu
- Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Shing Chen
- Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yu Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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