Earlier nephrology consultation may not be associated with improved short-term survival of acute kidney injury in very elderly men

Nephrologist follow-up care for the acute kidney injury-chronic kidney disease continuum and clinical outcomes: A systematic review and meta-analysis

BACKGROUND

Acute kidney injury (AKI) to chronic kidney disease (CKD) continuum will increase patients' risk of mortality and long-term dialysis. The aim of the present meta-analysis is to explore the effectiveness of nephrologist care and focus on the follow-up in patients with AKI.

METHODS

A systematic search of studies on nephrologist care for the AKI to CKD continuum has been conducted from PubMed and other different databases. Briefly, the primary outcome is the odds ratio of mortality as well as the secondary outcome is de novo renal replacement therapy.

RESULTS

This research includes one randomized controlled trial (RCT) and four cohort studies comprised of 15 541 participants in total. The quantitative analysis displays a lower mortality rate with nephrologist care versus non-nephrologist care in patients' discharge after a hospitalization complicated by AKI (odds ratio: 0.768; 95% CI, 0.616-0.956). By means of Trial Sequential Analysis (TSA), we conclude that nephrologist care after an AKI episode declines 30% relative risks of all-cause mortality.

CONCLUSION

Nephrologist care for AKI patients after a hospitalization significantly has reduced mortality compared to those followed up by non-nephrologists. There is a trend toward a potentially superior survival rate with nephrologist care has been going well in the recent years.

Sociodemographic and clinical characteristics of early COVID-19 deaths in Almadinah Almonawarah, Saudi Arabia: An analytical cross-sectional study

Background and Objective

Identification of clinical characteristics and risk factors for mortality in COVID-19 is important for early detection and precise case management. The study aimed to describe the sociodemographic, clinical, and laboratory characteristics of in-hospital COVID-19 deaths in Almadinah Almonawarah city, Saudi Arabia, and to identify risk factors for early mortality among them.

Methods

This is an analytical cross-sectional study. The main outcomes were demographic and clinical characteristics of COVID 19 patients who died from March till December 2020, during the hospital stay. We collected 193 records of COVID-19 patients, from two major hospitals in Al Madinah region, Saudi Arabia. Descriptive and inferential analysis were performed to identify and relate the factors of early death.

Results

Out of the total deaths, 110 died during the first 14 days of admission (Early death group) and 83 died after 14 days of admission (Late death group). Early death group had a significantly higher percentages of old age patients (p=0.027) and males (72.7%). Comorbidities were found in 166 (86%) of cases. Multimorbidity were significantly higher in early deaths than in late deaths 74.5% (p=<0.001). Women had significantly higher mean values of CHA2SD2 comorbidity scores (3.28 versus 1.89 for men; p <0.001). Moreover, predictors of high comorbidity scores were older age (p=0.005), higher respiratory rate (p=0.035), and raised alanine transaminase (p=0.047).

Conclusion

Old age, comorbid illness, and severe respiratory involvement were prevalent among COVID-19 deaths. Comorbidity scores were significantly higher in women. Comorbidity was found to be significantly more associated with early deaths.

Duration of acute kidney injury predicts 90-day mortality and chronic kidney disease progression in elderly patients

Background

This study evaluated the prognostic impact of acute kidney injury (AKI) duration on 90-d mortality and new-onset chronic kidney disease (CKD) progression in elderly patients.

Methods

We retrospectively enrolled elderly patients (≥75 years; n = 693) from the Chinese PLA General Hospital between January 1, 2007 and December 31, 2018. The 2012 Kidney Disease Improving Global Outcomes (KDIGO) defined serum creatinine (Scr) criteria were used to identify and classify AKI. Patients were divided into transient AKI (T-AKI) and persistent AKI (P-AKI) groups based on whether Scr levels returned to baseline within 48 h post-AKI. We further classified P-AKI based on AKI duration: (1) short duration: resolving AKI lasting 3-4 days; (2) medium duration: resolving AKI lasting 5-7 days; and (3) long duration: AKI lasting >7 days.

Results

Among patients, 62 (9.0%) had T-AKI (1-2 days), 104 (15.0%) had short-duration, 140 (20.2%) had medium-duration, and 387 (55.8%) had long-duration. In total, 209 (30.2%) died within 90 days; 122 (25.2%) developed CKD. After adjusting for multiple covariates, duration of AKI (3-4 days: hazard ratio [HR] = 2.512; P =0.045; 5-7 days: HR=3.154; P =0.015; >7 days: HR=6.212; P<0.001) was significantly associated with a higher 90-day mortality. Longer AKI duration (3-4 days: odds ratio [OR] = 0.982; P =0.980; 5-7 days: OR=1.322; P =0.661; >7 days: OR=7.007; P<0.001) was significantly associated with new-onset CKD of survivors.

Conclusion

AKI duration is useful for predicting poorer clinical outcomes in elderly patients, emphasizing the importance of identifying an appropriate treatment window for early intervention.