Clinical outcomes of acute kidney injury developing outside the hospital in elderly

PURPOSE

Although various studies have improved our knowledge about the clinical features and outcomes of acute kidney injury developing in the hospital (AKI-DI) in elderly subjects, data about acute kidney injury developing outside the hospital (AKI-DO) in elderly patients (age ≥ 65 years) are still extremely limited. This study was performed to investigate prevalence, clinical outcomes, hospital cost and related factors of AKI-DO in elderly and very elderly patients.

METHODS

We conducted a prospective, observational study in patients (aged ≥ 65 years) who were admitted to our center between May 01, 2012, and May 01, 2013. Subjects with AKI-DO were divided into two groups as "elderly" (group 1, 65-75 years old) and "very elderly" (group 2, >75 years old). Control group (group 3) consisted of the hospitalized patients aged 65 years and older with normal serum creatinine level. In-hospital outcomes and 6-month outcomes were recorded. Rehospitalization rate within 6 months of discharge was noted. Hospital costs and mortality rates of each group were investigated. Risk factors for AKI-DO were determined.

RESULTS

The incidence of AKI-DO that required hospitalization in elderly and very elderly patients was 5.8 % (136/2324) and 11 % (100/905), respectively (p < 0.001), with an overall incidence of 7.3 % (236/3229). Chronic kidney disease (CKD) was developed in 43.4 % of group 1 and 67 % of group 2 within the 6 months of discharge (p < 0.001). Progression to CKD was significantly lower in the control group than in groups 1 and 2 (p < 0.001). Mortality rates for groups 1, 2 and 3 were 23.5 % (n = 32), 31 % (n = 31) and 4.2 % (n = 8), respectively (p < 0.05). Rehospitalization rate within the 6 months of discharge for the groups with AKI-DO was higher than for the control group (p < 0.001). Hospital cost of groups 1 and 2 was significantly higher than that of the control group (p < 0.001). Nonsteroidal anti-inflammatory drugs (NSAIDs) (OR: 6.839, 95 % CI = 4.392-10.648), angiotensin-converting enzyme inhibitors (ACEI) (OR: 7.846, 95 % CI = 5.161-11.928), angiotensin receptor blockers (ARB) (OR: 6.466, 95 % CI = 4.813-8.917), radiocontrast agents (OR: 8.850, 95 % CI = 5.857-13.372), hypertension (OR: 4.244, 95 % CI = 2.729-6.600), diabetes mellitus (OR: 2.303, 95 % CI = 1.411-3.761), heart failure (OR: 3.647, 95 % CI = 2.276-5.844) and presence of infection (OR: 3.149, 95 % CI = 1.696-5.845) were found as the risk factors for AKI-DO in elderly patients (p < 0.001 for all). Patients with AKI-DO had higher 6-month mortality rate (HR 1.721, 95 % CI: 1.451-2.043, p < 0.001). Mortality risk increased 0.519 times at 20th day.

CONCLUSIONS

The incidence of AKI-DO requiring hospitalization is higher in very elderly patients than elderly ones, especially in male gender. Use of ACEI, ARB, NSAID and radiocontrast agents is the main risk factors for the development of AKI-DO in the elderly.

Recurrent Acute Kidney Injury in Renal Transplant Patients: A Single-Center Study

OBJECTIVE

Renal transplant patients may have recurrent episodes of acute kidney injury (AKI) during the posttransplant period. Determination and management of risk factors may help to prevent recurrence of AKI and allograft loss. In this study, we investigated the clinical features of renal transplant patients with recurrent AKI and evaluated etiologies and risk factors.

MATERIALS AND METHODS

A total of 19 patients with 79 AKI episodes were examined retrospectively. AKI classes, etiologies, and risk factors were investigated. Their features were compared with 38 renal transplant patients without AKI.

RESULTS

Distribution of AKI episodes according to the type of injury was as follows: 15 prerenal, 43 renal, 6 postrenal, and 15 mixed. Renal transplant patients with recurrent AKI had a greater duration of dialysis before transplantation (P < .05). Logistic regression analysis revealed no predictor for recurrent AKI after renal transplantation. Infections participated in the development of 45 AKI episodes. Chronic kidney disease developed in 16 patients.

CONCLUSION

Infections are the leading condition associated with recurrent AKI in renal transplant patients. Recurrent AKI may contribute to the development and progression of chronic kidney injury.

How do we measure blood pressure at home?

BACKGROUND

Home blood pressure monitoring (HBPM) is one of the measures that increases compliance with antihypertensive therapy. HBPM requires a proper measurement technique as well as an accurate sphygmomanometer. The aim of this study was to assess the characteristics of home sphygmomanometers (HS) in a big city in Turkey.

SUBJECTS AND METHOD

We assessed the HS of hypertensive patients (n = 452; male: 253, female: 199) who were examined for the first time in our outpatient center. General evaluation of HS included trademark, model, device's age, cuff size, validation and calibration status.

RESULTS

We interviewed 452 patients and 452 HS were identified. The most common factors affecting the patients' choice for the type and model of the HS were its simplicity and ease of use (28.2%), followed by advertisements (44%), physician's advice (19.3%) and the belief in accurate measurement (< 1%). All patients were unaware of validation and calibration of their devices.

CONCLUSION

Awareness of both patients and physicians about the validation status of HS is not enough. Some complaints from patients may be associated with using non-validated HS. There is a need for a policy or standard criteria for HS.

Red Blood Cell Distribution Width Level: A Predictive Marker for Early Detection and Monitoring of Diabetic Nephropathy Progression

Chronic inflammation may be one of the factors that contribute to the development of diabetic nephropathy (DN). However, erythropoiesis, erythrocyte circulatory half-life and erythrocyte deformability may be influenced by inflammation. Thus, red blood cell distribution width (RDW) levels increase in inflammatory conditions. We investigated the RDW values and related factors in patients with uncomplicated type 2 diabetes mellitus (DM) and diabetic patients with DN. We carried out a retrospective study on patients with type 2 DM admitted to our hospital. Subjects were divided into three groups. Group 1 consisted of healthy subjects. Group 2 consisted of patients with uncomplicated type 2 DM. Patients with various stages of DN were included in Group 3. The RDW values in group 1 subjects were significantly lower than those in group 2 and 3 patients (p<0.05). The RDW values of group 3 patients were higher than those in the other two groups (p<0.05). While the RDW values had positive correlation with blood pressure, serum creatinine, HbA1c, body mass index, proteinuria, platelet (PLT), triglyceride, low density lipoprotein (LDL), total cholesterol (TC), and fasting blood glucose (r values: 0.95, 0.72, 0.56, 0.86, 0.82, 0.76, 0.88, 0.84, 0.88, 0.86, respectively) (p<0.05 for all), there was negative correlation between estimated glomerular filtration rate (eGFR), albumin, high density lipoprotein (HDL) and RDW levels (r values: −0.92, −0. 88, −0.78, respectively) (p value < 0.05 for all).