Kidney injury: the case of elderly patients

  • Alexandra Chronopoulos
  • Mitchell H. Rosner
  • Dinna N. Cruz
  • Claudio Ronco
Atti Vicenza 26–27 Maggio 2011
  • 43 Downloads

Abstract

There is a high risk of acute kidney injury (AKI) in the elderly population. The demand for intensive care unit (ICU) admission from older patients is rising, and with it community and hospital acquired AKI are becoming more frequent. Several age-related changes render elderly patients prone to AKI development. The most frequent aetiologies for renal impairment in these patients are recent surgery, sepsis and dehydration. It is sometimes difficult to achieve an early diagnosis in the elderly ICU patient, and new biomarkers such as neutrophil gelatinase-associated lipocalin may offer a new approach. AKI treatment in this age group may be even more complex than in the general population. There are data on differences in renal recovery and mortality between the young and the old with renal injury which indicate a higher risk in fragile elderly individuals. Furthermore, it is crucial to establish all possible measures for AKI prevention in the elderly critically ill patient, since once AKI is established, mortality increases significantly.

Key words

Elderly Aging Acute kidney injury Acute renal failure Intensive care Critical illness 

Danno renale acuto nella popolazione anziana

Riassunto

Nella popolazione anziana il rischio di danno renale acuto (AKI) è elevato. Il numero di ricoveri di persone anziane in terapia intensiva (ICU) è in crescente aumento e di conseguenza il danno renale acuto acquisito in comunità e in ospedale sta diventando sempre più frequente. Molti cambiamenti legati all’età rendono questi soggetti maggiormente esposti allo sviluppo di insufficienza renale acuta. Talvolta è difficile porre precocemente la diagnosi nell’aziano ricoverato in ICU, e nuovi biomarcatori, come l’ENGAL, posso offrire nuove possibilità. Il trattamento dell’insufficienza renale acuta in questa classe di età può essere anche più complesso che nella popolazione generale. Dati comparativi sul recupero renale e sulla mortalità tra la popolazione giovane e nella terza età dimostrano un maggiore rischio per gli individui anziani fragili. Inoltre, é cruciale definire tutte le possibili misure di prevenzione dell’insufficienza renale acuta nei pazienti critici oltre i 60 anni, poiché una volta che l’insufficienza renale acuta si è manifestata, la mortalità aumenta in modo significativo.

Parole chiave

Anziano Invecchiamento Danno Renale Acuto Insufficienza Renale Acuta Terapia intensiva Malattia 

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References

  1. 1.
    Lieberman D, Nachshon L, Miloslavsky O et al (2009) How do older ventilated patients fare? A survival/functional analysis of 641 ventilations. J Crit Care 24:340–346PubMedCrossRefGoogle Scholar
  2. 2.
    Shahidi S, Schroeder TV, Carstensen M, Sillesen H (2009) Outcome and survival of patients aged 75 years and older compared to younger patients after ruptured abdominal aortic aneurysm repair: do the results justify the effort? Ann Vasc Surg 23:469–477PubMedCrossRefGoogle Scholar
  3. 3.
    Foerch C, Kessler KR, Steckel DA et al (2004) Survival and quality of life outcome after mechanical ventilation in elderly stroke patients. J Neurol Neurosurg Psychiatry 75:988–993PubMedCrossRefGoogle Scholar
  4. 4.
    United Nations (2009) World population ageing: 1950–2050. Department of Economic and Social Affairs, Population Division, United Nations. http://www.un.org/esa/populationpublications/worldageing19502050. Accessed 5 May 2011
  5. 5.
    Chang CH, Lin CY, Tian YC et al (2010) Acute kidney injury classification: comparison of AKIN and RIFLE criteria. Shock 33:247–252PubMedCrossRefGoogle Scholar
  6. 6.
    Kellum JA, Angus DC (2002) Patients are dying of acute renal failure. Crit Care Med 30:2156–2157PubMedCrossRefGoogle Scholar
  7. 7.
    Lopes JA, Fernandes P, Jorge S et al (2008) Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care 12:R110PubMedCrossRefGoogle Scholar
  8. 8.
    Bagshaw SM, George C, Bellomo R (2008) A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 23:1569–1574PubMedCrossRefGoogle Scholar
  9. 9.
    Joannidis M, Metnitz B, Bauer P et al (2009) Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 35:1692–1770PubMedCrossRefGoogle Scholar
  10. 10.
    Angus DC, Barnato AE, Linde-Zwirble WT et al (2004) Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 32:638–643PubMedCrossRefGoogle Scholar
  11. 11.
    Bagshaw SM, Webb SA, Delaney A et al (2009) Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 13:R45PubMedCrossRefGoogle Scholar
  12. 12.
    Uchino S, Kellum JA, Bellomo R et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818PubMedCrossRefGoogle Scholar
  13. 13.
    de Mendonça A, Vincent JL, Suter PM et al (2000) Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 26:915–921PubMedCrossRefGoogle Scholar
  14. 14.
    Akposso K, Hertig A, Couprie R et al (2000) Acute renal failure in patients over 80 years old: 25-years’ experience. Intensive Care Med 26:400–406PubMedCrossRefGoogle Scholar
  15. 15.
    Feest TG, Round A, Hamad S (1993) Incidence of severe acute renal failure in adults: results of a community based study. BMJ 306:481–483PubMedCrossRefGoogle Scholar
  16. 16.
    Choudhury DRD, Levi M (2004) Effect of aging on renal function ad disease. Saunders, Philadelphia, PAGoogle Scholar
  17. 17.
    Esposito C, Plati A, Mazzullo T et al (2007) Renal function and functional reserve in healthy elderly individuals. J Nephrol 20:617–625PubMedGoogle Scholar
  18. 18.
    Wald H (1937) The weight of normal adult human kidneys and its variability. Arch Pathol Lab Med 23:493–500Google Scholar
  19. 19.
    Tauchi H, Tsuboi K, Okutomi J (1971) Age changes in the human kidney of the different races. Gerontologia 17:87–97PubMedCrossRefGoogle Scholar
  20. 20.
    Goyal VK (1982) Changes with age in the human kidney. Exp Gerontol 17:321–331PubMedCrossRefGoogle Scholar
  21. 21.
    McLachlan MS (1978) The ageing kidney. Lancet 2:143–145PubMedCrossRefGoogle Scholar
  22. 22.
    Kaplan C, Pasternack B, Shah H, Gallo G (1975) Age-related incidence of sclerotic glomeruli in human kidneys. Am J Pathol 80:227–234PubMedGoogle Scholar
  23. 23.
    Kappel B, Olsen S (1980) Cortical interstitial tissue and sclerosed glomeruli in the normal human kidney, related to age and sex. A quantitative study. Virchows Arch A Pathol Anat Histol 387:271–277CrossRefGoogle Scholar
  24. 24.
    Epstein M (1996) Aging and the kidney. J Am Soc Nephrol 7:1106–1122PubMedGoogle Scholar
  25. 25.
    Andres R (1969) Physiological factors of aging significant to the clinician. J Am Geriatr Soc 17:274–283PubMedGoogle Scholar
  26. 26.
    Lindeman RD, Tobin J, Shock NW (1985) Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 33:278–285PubMedGoogle Scholar
  27. 27.
    Rowe JW, Andres R, Tobin JD et al (1976) The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol 31:155–163PubMedGoogle Scholar
  28. 28.
    Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612PubMedGoogle Scholar
  29. 29.
    Fliser D (2005) Ren sanus in corpore sano: the myth of the inexorable decline of renal function with senescence. Nephrol Dial Transplant 20:482–485PubMedCrossRefGoogle Scholar
  30. 30.
    Fliser D, Zeier M, Nowack R, Ritz E (1993) Renal functional reserve in healthy elderly subjects. J Am Soc Nephrol 3:1371–1377PubMedGoogle Scholar
  31. 31.
    Lakatta EG (1993) Cardiovascular regulatory mechanisms in advanced age. Physiol Rev 73:413–467PubMedGoogle Scholar
  32. 32.
    Zhang XZ, Qiu C, Baylis C (1997) Sensitivity of the segmental renal arterioles to angiotensin II in the aging rat. Mech Ageing Dev 97:183–192PubMedCrossRefGoogle Scholar
  33. 33.
    Baylis C, Fredericks M, Wilson C et al (1990) Renal vasodilatory response to intravenous glycine in the aging rat kidney. Am J Kidney Dis 15:244–251PubMedGoogle Scholar
  34. 34.
    Davies DF, Shock NW (1950) Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. J Clin Invest 29:496–507PubMedCrossRefGoogle Scholar
  35. 35.
    Aymanns C, Keller F, Maus S et al (2010) Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clin J Am Soc Nephrol 5:314–327PubMedCrossRefGoogle Scholar
  36. 36.
    Martin JE, Sheaff MT (2007) Renal ageing. J Pathol 211:198–205PubMedCrossRefGoogle Scholar
  37. 37.
    Epstein M, Hollenberg NK (1976) Age as a determinant of renal sodium conservation in normal man. J Lab Clin Med 87:411–417PubMedGoogle Scholar
  38. 38.
    Mulkerrin EC, Brain A, Hampton D et al (1993) Reduced renal hemodynamic response to atrial natriuretic peptide in elderly volunteers. Am J Kidney Dis 22:538–544PubMedGoogle Scholar
  39. 39.
    Mulkerrin E, Epstein FH, Clark BA (1995) Reduced renal response to low-dose dopamine infusion in the elderly. J Gerontol A Biol Sci Med Sci 50:M271–275PubMedCrossRefGoogle Scholar
  40. 40.
    Muhlberg W, Platt D (1999) Age-dependent changes of the kidneys: pharmacological implications. Gerontology 45:243–253PubMedCrossRefGoogle Scholar
  41. 41.
    Schmitt R, Cantley LG (2008) The impact of aging on kidney repair. Am J Physiol Renal Physiol 294:F1265–1272PubMedCrossRefGoogle Scholar
  42. 42.
    Epstein FH, Prasad P (2000) Effects of furosemide on medullary oxygenation in younger and older subjects. Kidney Int 57:2080–2083PubMedCrossRefGoogle Scholar
  43. 43.
    Chou JS, Reiser IW, Porush JG (1997) Aging and urinary excretion of epidermal growth factor. Ann Clin Lab Sci 27:116–122PubMedGoogle Scholar
  44. 44.
    Tran KT, Rusu SD, Satish L, Wells A (2003) Aging-related attenuation of EGF receptor signaling is mediated in part by increased protein tyrosine phosphatase activity. Exp Cell Res 289:359–367PubMedCrossRefGoogle Scholar
  45. 45.
    Pascual J, Liaño F, Ortuno J (1995) The elderly patient with acute renal failure. J Am Soc Nephrol 6:144–153PubMedGoogle Scholar
  46. 46.
    Ronco C, Chionh CY, Haapio M et al (2009) The cardiorenal syndrome. Blood Purif 27:114–126PubMedCrossRefGoogle Scholar
  47. 47.
    Ali T, Khan I, Simpson W et al (2007) Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol 18:1292–1298PubMedCrossRefGoogle Scholar
  48. 48.
    Rosner M (2009) Acute kidney injury in the elderly: pathogenesis, diagnosis and therapy. Aging Health 5:1–10CrossRefGoogle Scholar
  49. 49.
    Cheung CM, Ponnusamy A, Anderton JG (2008) Management of acute renal failure in the elderly patient: a clinician’s guide. Drugs Aging 25:455–476PubMedCrossRefGoogle Scholar
  50. 50.
    Gill J, Malyuk R, Djurdjev O, Levin A (2007) Use of GFR equations to adjust drug doses in an elderly multi-ethnic group — a cautionary tale. Nephrol Dial Transplant 22:2894–2899PubMedCrossRefGoogle Scholar
  51. 51.
    Jerkic M, Vojvodic S, Lopez-Novoa JM (2001) The mechanism of increased renal susceptibility to toxic substances in the elderly. Part I. The role of increased vasoconstriction. Int Urol Nephrol 32:539–547PubMedCrossRefGoogle Scholar
  52. 52.
    McCullough PA, Adam A, Becker CR et al (2006) Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol 98:5K–13KPubMedCrossRefGoogle Scholar
  53. 53.
    Sidhu RB, Brown JR, Robb JF et al (2008) Interaction of gender and age on post cardiac catheterization contrast-induced acute kidney injury. Am J Cardiol 102:1482–1486PubMedCrossRefGoogle Scholar
  54. 54.
    McGillicuddy EA, Schuster KM, Kaplan LJ et al (2010) Contrast-induced nephropathy in elderly trauma patients. J Trauma 68:294–297PubMedCrossRefGoogle Scholar
  55. 55.
    Noor S, Usmani A (2008) Postoperative renal failure. Clin Geriatr Med 24:721–729PubMedCrossRefGoogle Scholar
  56. 56.
    Mangano CM, Diamondstone LS, Ramsay JG et al (1998) Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 128:194–203Google Scholar
  57. 57.
    Antunes PE, Prieto D, Ferrao de Oliveira J, Antunes MJ (2004) Renal dysfunction after myocardial revascularization. Eur J Cardiothorac Surg 25:597–604PubMedCrossRefGoogle Scholar
  58. 58.
    Scott BH, Seifert FC, Grimson R, Glass PS (2005) Octogenarians undergoing coronary artery bypass graft surgery: resource utilization, postoperative mortality, and morbidity. J Cardiothorac Vasc Anesth 19:583–588PubMedCrossRefGoogle Scholar
  59. 59.
    Kheterpal S, Tremper KK, Englesbe MJ et al (2007) Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology 107:892–902PubMedCrossRefGoogle Scholar
  60. 60.
    Svensson LG, Coselli JS, Safi HJ et al (1989) Appraisal of adjuncts to prevent acute renal failure after surgery on the thoracic or thoracoabdominal aorta. J Vasc Surg 10:230–239PubMedGoogle Scholar
  61. 61.
    Svensson LG, Crawford ES, Hess KR et al (1993) Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 17:357–368; discussion 368–370PubMedCrossRefGoogle Scholar
  62. 62.
    Abelha FJ, Botelho M, Fernandes V, Barros H (2009) Determinants of postoperative acute kidney injury. Crit Care 13:R79PubMedCrossRefGoogle Scholar
  63. 63.
    Abelha FJ, Botelho M, Fernandes V, Barros H (2009) Outcome and quality of life of patients with acute kidney injury after major surgery. Nefrologia 29:404–414PubMedGoogle Scholar
  64. 64.
    Jones DR, Lee HT (2009) Surgery in the patient with renal dysfunction. Anesthesiol Clin 27:739–749PubMedCrossRefGoogle Scholar
  65. 65.
    Reddy VG (2002) Prevention of postoperative acute renal failure. J Postgrad Med 48:64–70PubMedGoogle Scholar
  66. 66.
    Bellomo R, Wan L, Langenberg C, May C (2008) Septic acute kidney injury: new concepts. Nephron Exp Nephrol 109:e95–100PubMedCrossRefGoogle Scholar
  67. 67.
    Bagshaw SM, Uchino S, Bellomo R et al (2007) Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol 2:431–439PubMedCrossRefGoogle Scholar
  68. 68.
    Pascual J, Liaño F (1998) Causes and prognosis of acute renal failure in the very old. Madrid Acute Renal Failure Study Group. J Am Geriatr Soc 46:721–725Google Scholar
  69. 69.
    Baraldi A, Ballestri M, Rapana R et al (1998) Acute renal failure of medical type in an elderly population. Nephrol Dial Transplant 13(Suppl 7):25–29PubMedCrossRefGoogle Scholar
  70. 70.
    Lameire N, Matthys E, Vanholder R et al (1987) Causes and prognosis of acute renal failure in elderly patients. Nephrol Dial Transplant 2:316–322PubMedGoogle Scholar
  71. 71.
    Kohli HS, Bhat A, Aravindan et al (2006) Spectrum of renal failure in elderly patients. Int Urol Nephrol 38:759–765PubMedCrossRefGoogle Scholar
  72. 72.
    Moran SM, Myers BD (1985) Course of acute renal failure studied by a model of creatinine kinetics. Kidney Int 27:928–937PubMedCrossRefGoogle Scholar
  73. 73.
    Lameire N, Hoste E (2004) Reflections on the definition, classification, and diagnostic evaluation of acute renal failure. Curr Opin Crit Care 10:468–475PubMedCrossRefGoogle Scholar
  74. 74.
    Hoste EA, Damen J, Vanholder RC et al (2005) Assessment of renal function in recently admitted critically ill patients with normal serum creatinine. Nephrol Dial Transplant 20:747–753PubMedCrossRefGoogle Scholar
  75. 75.
    Soni SS, Cruz D, Bobek I et al (2010) NGAL: a biomarker of acute kidney injury and other systemic conditions. Int Urol Nephrol 42:141–150PubMedCrossRefGoogle Scholar
  76. 76.
    Shlipak MG, Sarnak MJ, Katz R et al (2005) Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med 352:2049–2060PubMedCrossRefGoogle Scholar
  77. 77.
    Parikh CR, Abraham E, Ancukiewicz M, Edelstein CL (2005) Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit. J Am Soc Nephrol 16:3046–3052PubMedCrossRefGoogle Scholar
  78. 78.
    Siew ED, Ware LB, Gebretsadik T et al (2009) Urine neutrophil gelatinase-associated lipocalin moderately predicts acute kidney injury in critically ill adults. J Am Soc Nephrol 20:1823–1832PubMedCrossRefGoogle Scholar
  79. 79.
    Han WK, Wagener G, Zhu Y et al (2009) Urinary biomarkers in the early detection of acute kidney injury after cardiac surgery. Clin J Am Soc Nephrol 4:873–882PubMedCrossRefGoogle Scholar
  80. 80.
    Haase M, Bellomo R, Devarajan P et al (2009) Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and metaanalysis. Am J Kidney Dis 54:1012–1024PubMedCrossRefGoogle Scholar
  81. 81.
    Joannidis M, Druml W, Forni LG et al (2010) Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the Working Group for Nephrology, ESICM. Intensive Care Med 36:392–411PubMedCrossRefGoogle Scholar
  82. 82.
    Anderson WP, Korner PI, Selig SE (1981) Mechanisms involved in the renal responses to intravenous and renal artery infusions of noradrenaline in conscious dogs. J Physiol 321:21–30PubMedGoogle Scholar
  83. 83.
    Bellomo R, Kellum JA, Wisniewski SR, Pinsky MR (1999) Effects of norepinephrine on the renal vasculature in normal and endotoxemic dogs. Am J Respir Crit Care Med 159:1186–1192PubMedGoogle Scholar
  84. 84.
    Albanese J, Leone M, Garnier F et al (2004) Renal effects of norepinephrine in septic and nonseptic patients. Chest 126:534–539PubMedCrossRefGoogle Scholar
  85. 85.
    Martin C, Papazian L, Perrin G et al (1993) Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 103:1826–1831PubMedCrossRefGoogle Scholar
  86. 86.
    Sakr Y, Reinhart K, Vincent JL et al (2006) Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med 34:589–597PubMedCrossRefGoogle Scholar
  87. 87.
    Boulain T, Runge I, Bercault N et al (2009) Dopamine therapy in septic shock: detrimental effect on survival? J Crit Care 24:575–582PubMedCrossRefGoogle Scholar
  88. 88.
    Povoa PR, Carneiro AH, Ribeiro OS, Pereira AC (2009) Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care Med 37:410–416PubMedCrossRefGoogle Scholar
  89. 89.
    Martin C, Viviand X, Leone M, Thirion X (2000) Effect of norepinephrine on the outcome of septic shock. Crit Care Med 28:2758–2765PubMedCrossRefGoogle Scholar
  90. 90.
    Russell JA, Walley KR, Singer J et al (2008) Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 358:877–887PubMedCrossRefGoogle Scholar
  91. 91.
    Gordon AC, Russell JA, Walley KR et al (2010) The effects of vasopressin on acute kidney injury in septic shock. Intensive Care Med 36:83–91PubMedCrossRefGoogle Scholar
  92. 92.
    De Backer D, Biston P, Devriendt J et al (2010) Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 362:779–789PubMedCrossRefGoogle Scholar
  93. 93.
    Patel GP, Grahe JS, Sperry M et al (2010) Efficacy and safety of dopamine versus norepinephrine in the management of septic shock. Shock 33:375–380PubMedCrossRefGoogle Scholar
  94. 94.
    Albanese J, Leone M, Delmas A, Martin C (2005) Terlipressin or norepinephrine in hyperdynamic septic shock: a prospective, randomized study. Crit Care Med 33:1897–1902PubMedCrossRefGoogle Scholar
  95. 95.
    Myburgh JA, Higgins A, Jovanovska A et al (2008) A comparison of epinephrine and norepinephrine in critically ill patients. Intensive Care Med 34:2226–2234PubMedCrossRefGoogle Scholar
  96. 96.
    Annane D, Vignon P, Renault A et al (2007) Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet 370:676–684PubMedCrossRefGoogle Scholar
  97. 97.
    Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRefGoogle Scholar
  98. 98.
    Perel A (2008) Bench-to-bedside review: the initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines — does one size fit all? Crit Care 12:223PubMedCrossRefGoogle Scholar
  99. 99.
    Wilkes NJ, Woolf R, Mutch M et al (2001) The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 93:811–816PubMedCrossRefGoogle Scholar
  100. 100.
    Boldt J, Suttner S, Brosch C et al (2009) The influence of a balanced volume replacement concept on inflammation, endothelial activation, and kidney integrity in elderly cardiac surgery patients. Intensive Care Med 35:462–470PubMedCrossRefGoogle Scholar
  101. 101.
    Cruz DN, Bolgan I, Perazella MA et al (2007) North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE criteria. Clin J Am Soc Nephrol 2:418–425PubMedCrossRefGoogle Scholar
  102. 102.
    Bonello M, Petras D, Ricci Z et al (2009) Acute renal failure in the elderly critically ill patient. In: Ronco C, Bellomo R, Kellum JA (ed) Critical care nephrology. Saunders Elsevier, Philadelphia, pp. 1675–1680Google Scholar
  103. 103.
    Henrich WL (1990) Dialysis considerations in the elderly patient. Am J Kidney Dis 16:339–341PubMedGoogle Scholar
  104. 104.
    Hsieh C-W, Chen H-H (2007) Continuous renal replacement therapy for acute renal failure in the elderly. Int J Gerontol 1:46–51CrossRefGoogle Scholar
  105. 105.
    Garrouste-Orgeas M, Timsit JF, Montuclard L et al (2006) Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med 32:1045–1051PubMedCrossRefGoogle Scholar
  106. 106.
    Somme D, Maillet JM, Gisselbrecht M et al (2003) Critically ill old and the oldest-old patients in intensive care: short- and longterm outcomes. Intensive Care Med 29:2137–2143PubMedCrossRefGoogle Scholar
  107. 107.
    Bagshaw SM, Laupland KB, Doig CJ et al (2005) Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care 9:R700–709PubMedCrossRefGoogle Scholar
  108. 108.
    Van Den Noortgate N, Mouton V, Lamot C et al (2003) Outcome in a post-cardiac surgery population with acute renal failure requiring dialysis: does age make a difference? Nephrol Dial Transplant 18:732–736CrossRefGoogle Scholar
  109. 109.
    Gopal I, Bhonagiri S, Ronco C, Bellomo R (1997) Out of hospital outcome and quality of life in survivors of combined acute multiple organ and renal failure treated with continuous venovenous hemofiltration/hemodiafiltration. Intensive Care Med 23:766–772PubMedCrossRefGoogle Scholar
  110. 110.
    Morgera S, Kraft AK, Siebert G et al (2002) Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies. Am J Kidney Dis 40:275–279PubMedCrossRefGoogle Scholar
  111. 111.
    Khosla N, Soroko SB, Chertow GM et al (2009) Preexisting chronic kidney disease: a potential for improved outcomes from acute kidney injury. Clin J Am Soc Nephrol 4:1914–1919PubMedCrossRefGoogle Scholar
  112. 112.
    Schmitt R, Coca S, Kanbay M et al (2008) Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis 52:262–271PubMedCrossRefGoogle Scholar
  113. 113.
    Schiffl H, Fischer R (2008) Five-year outcomes of severe acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant 23:2235–2241PubMedCrossRefGoogle Scholar
  114. 114.
    Wald R, Quinn RR, Luo J et al (2009) Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 302:1179–1185PubMedCrossRefGoogle Scholar
  115. 115.
    Macedo E, Bouchard J, Mehta RL (2008) Renal recovery following acute kidney injury. Curr Opin Crit Care 14:660–665PubMedCrossRefGoogle Scholar
  116. 116.
    Michalsen A (2009) Some thoughts on intensive care for elderly patients at the end of their lives. ICU Management 9:8–10Google Scholar
  117. 117.
    Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B (2007) Should elderly patients be admitted to the intensive care unit? Intensive Care Med 33:1252–1262PubMedCrossRefGoogle Scholar
  118. 118.
    Iribarren-Diarasarri S, Aizpuru-Barandiaran F, Munoz-Martinez T et al (2009) Health-related quality of life as a prognostic factor of survival in critically ill patients. Intensive Care Med 35:833–839PubMedCrossRefGoogle Scholar
  119. 119.
    Sacanella E, Perez-Castejon JM, Nicolas JM et al (2009) Mortality in healthy elderly patients after ICU admission. Intensive Care Med 35:550–555PubMedCrossRefGoogle Scholar
  120. 120.
    Ridley S, Morris S (2007) Cost effectiveness of adult intensive care in the UK. Anaesthesia 62:547–554PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Alexandra Chronopoulos
    • 1
  • Mitchell H. Rosner
    • 2
  • Dinna N. Cruz
    • 3
  • Claudio Ronco
    • 3
    • 4
  1. 1.Department of MedicineHôpital Hôtel-Dieu de LévisLévisCanada
  2. 2.Division of NephrologyUniversity of Virginia Health SystemCharlottesvilleUSA
  3. 3.International Renal Research Institute Vicenza (IRRIV)VicenzaItaly
  4. 4.Department of NephrologySan Bortolo HospitalVicenzaItaly

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