Dialysis Options for the Elderly Patient with Acute Kidney Injury

Abstract

Acute kidney injury (AKI) is a common and serious event that most often complicates hospitalization for serious illness [1]. Recent data demonstrates that from 2000 to 2009, the incidence of dialysis-requiring AKI increased from 222 to 533 cases per million person-years, an average increase of 10 % per year [2]. An important factor driving this increase in AKI over the past decade is the older age of the population, which serves as an independent risk factor for the development of AKI. It is now clear that the elderly are at the very highest risk for the development of AKI, and over the past 25 years, the mean age of patients with AKI has increased by at least 5 years and perhaps as much as 15 years [3]. In a large European cohort of patients, the average age of patients with AKI was 76 years [4]. Hsu et al. most recently also demonstrated that not only were elderly patients at higher risk for the most severe form of AKI (that requires dialysis) as compared to younger patients, but that over time the incidence of AKI in the elderly is increasing more rapidly than in younger cohorts [2]. At the more severe extremes of AKI, hospitalized patients with dialysis-requiring AKI are older than their counterparts without dialysis-requiring AKI (63.4 versus 47.6 years) [2].