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Differences in characteristics and risk factors for acute kidney injury between elderly and very elderly patients: a retrospective review

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Abstract

Background

Few epidemiologic studies on acute kidney injury (AKI) have focused on the older adult population. This study aimed to clarify the characteristics and risk factors for AKI in this population.

Methods

This retrospective observational study was performed with the clinical data of all outpatients and inpatients aged ≥ 65 years at the time of enrolment at Kochi Medical School Hospital between 1 January 1981 and 31 December 2021. The primary cohort was divided into those aged 65–74 and ≥ 75 years. The primary outcome was the occurrence of AKI.

Results

Of 83,822 patients, 38,333 were included in the 65–74-year-old group, whereas 45,489 were included in the ≥ 75-year-old group. Prevalences of the first AKI event in the 65–74-year-old and ≥ 75-year-old groups were 11.9% and 12.4%, respectively. Overall, lower estimated glomerular filtration rate, lower albumin level, lower or higher level of serum uric acid, and histories of diabetes mellitus, chronic heart failure, ischaemic heart disease, non-ischaemic heart disease, cerebrovascular disease, cancer, and liver disease were independent risk factors for an AKI event. The risk factors for AKI unique to each cohort were using non-steroidal anti-inflammatory drugs (NSAIDs) and loop diuretics (L-DI), and histories of hypertension (HT) and vascular diseases (VD) in men aged 65–74 years; using NSAIDs, angiotensin-converting enzyme inhibitors (ACEIs), L-DI and other diuretics (O-DI), and histories of HT and VD in men aged ≥ 75 years; using NSAIDs and O-DI and not using angiotensin-receptor blockers (ARBs), and a history of HT in women aged 65–74 years; and use of L-DI and a history of VD in women aged ≥ 75 years. Presence of proteinuria was a risk factor for develo** AKI.

Conclusions

Many AKI risk factors reported thus far are associated with AKI development. However, there are differences in the effects of the renin-angiotensin system inhibitors, ACEIs, and ARBs (ARBs may be protective). Additionally, the U-shaped relationship between AKI onset and uric acid levels differs between sexes in the elderly population, similar to other age groups, but this sex difference disappears in the very elderly population. Pre-existing chronic kidney disease is a risk factor for the development of AKI.

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Data availability

Data and analysis methods for this study are included in this article. Further information may be obtained upon request to the authors.

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Author notes

  1. Yutaka Hatakeyama and Taro Horino authors contributed equally to this work.

Authors and Affiliations

  1. Center of Medical Information Science, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan

    Yutaka Hatakeyama, Shigehiro Yasui & Yoshiyasu Okuhara

  2. Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan

    Taro Horino & Yoshio Terada

Authors
  1. Yutaka Hatakeyama
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  2. Taro Horino
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  3. Shigehiro Yasui
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  4. Yoshio Terada
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  5. Yoshiyasu Okuhara
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Contributions

YH, TH, and SY conceptualised and designed the study and performed the literature search. All authors collected and interpreted the data and wrote and revised the manuscript. All authors had full access to all the data in the study and accept responsibility for submitting the manuscript for publication. YH, TH, and SY had access to the raw data and verified them. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate.

Corresponding author

Correspondence to Taro Horino.

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Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (institutional review board approval number 23–15) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent to record and analyse data for research purposes was obtained from all study participants. Data were obtained from patients who completed a general consent form based on an opt-out policy at Kochi Medical School Hospital.

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Hatakeyama, Y., Horino, T., Yasui, S. et al. Differences in characteristics and risk factors for acute kidney injury between elderly and very elderly patients: a retrospective review. Clin Exp Nephrol (2024). https://doi.org/10.1007/s10157-024-02512-8

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