Abstract
The spectrum of acute renal failure (ARF) in the elderly population and the factors predicting poor outcome in these patients are not well defined in literature. Identification of risk factors and poor prognostic markers in these patients can help in planning strategies to prevent ARF and to prioritise the utilization of sparse and expensive therapeutic modalities, especially in a developing country like ours. We retrospectively analyzed data of 454 elderly patients (age ≥60 years), detected having ARF in a tertiary care super-speciality hospital in North India, from April 2000 to March 2004. The mean age of this population was 66.4 years with 70.5% being male. 64% patients had more than one precipitating factors for ARF, with volume depletion being the most common precipitating factor (33% cases). Infection/sepsis (21.6%) and drugs (11.5%) were other important precipitating factors. 31.8% were recorded as having oliguric ARF (urine output <400 ml/day) and 33.5% required renal replacement therapy (RRT). Acute peritoneal dialysis was the most frequent form of RRT given (62.5%). Mortality was 41.2% (187 cases), of whom 56 (29.8%) died inspite of recovery from ARF. Among the survivors, 103 patients (22.7%) had complete renal recovery, 141 (31.1%) had partial renal recovery, while 23 (8.6%), remained dialysis dependent. The factors which were found to be associated with increased mortality were; age ≥70 years, presence of previous chronic illness, ARF precipitated by cardiac failure and infection, need for RRT, oliguria and increasing numbers of failed organs. To conclude, ARF among elderly is a common problem in nephrology practice at our institute and is responsible for 48.9% of nephrology admissions/consultations among elderly patients. Majority of these patients are prone to multiple renal insults. Underlying chronic illness, presence of cardiac failure and sepsis, oliguria, need for RRT and increasing number of organ failure is associated with poor outcome.
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References
Statistical outline of India (1993) TATA services limited. 203
LJ Robbins SK Oholer (1990) The hospitalised elderly patient RW Schnier (Eds) Geriatric Medicine Saunders Philadelphia 54–67
J Pasucal F Liano J Ortuno (1995) ArticleTitleThe elderly patient with acute renal failure J Am Soc Nephrol 6 144–153
W Druml F Lax G Grimm B Schneeweiss K Lenz AN Laggner (1994) ArticleTitleAcute renal failure in the elderly Clin Nephrol 41 342–349 Occurrence Handle8076437 Occurrence Handle1:STN:280:ByuA2Mnps1Q%3D
HS Kohli MC Bhaskaran T Muthukumar K Thennarasu K Sud V Jha KL Gupta V Sakhuja (2000) ArticleTitleTreatment of related acute renal failure in the elderly: a hospital based prospective study Nephrol Dial Transplant 15 212–217 Occurrence Handle10648667 Occurrence Handle1:STN:280:DC%2BD3c7hsFyjtw%3D%3D Occurrence Handle10.1093/ndt/15.2.212
A Gentric F Duquesne J Cledes (1993) ArticleTitleIncidence, causes, prognosis of renal failure in old patients admitted in an internal medicine unit Geriatr Nephrol Urol 3 151–154 Occurrence Handle10.1007/BF01508809
K Klounche JP Cristol M Kaaki C Ture-Baron B Canaud JJ Beraud (1995) ArticleTitlePrognosis of acute renal failure in the elderly Nephrol Dial Transplant 10 2240–2243
JC Johnson (1983) ArticleTitleThe medical evaluation and management of the elderly surgical patient J Am Geriatr Soc 31 621 Occurrence Handle6619470 Occurrence Handle1:STN:280:BiuD3cfptVI%3D
MW Rich CA Crecelius (1990) ArticleTitleIncidence, risk factors and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older. A prospective study Arch Intern Med 150 1237–1242 Occurrence Handle2353856 Occurrence Handle1:STN:280:By%2BB1c3lslI%3D Occurrence Handle10.1001/archinte.150.6.1237
JH Gurwitz J Avorn D Ross-Dengan LA Lipsitz (1990) ArticleTitleNonsteroidal antiinflammatory drug-associated azotemia in the very old J Am Med Assoc 264 471–475 Occurrence Handle1:STN:280:By%2BA3cfovFE%3D Occurrence Handle10.1001/jama.264.4.471
SL Chew RL Lins R Daelemans ME Broe (1993) ArticleTitleOutcome in acute renal failure Nephrol Dial Transplant 8 101–107 Occurrence Handle8384329 Occurrence Handle1:STN:280:ByyB3critVw%3D
V Jha HS Malhotra V Sakhuja KS Chugh (1992) ArticleTitleSpectrum of hospital-acquired acute renal failure in developing countries—Chandigarh study Q J Med 84 497–505
F Liaño A Gallego J Ortuño (1989) ArticleTitleEasy and early prognosis in acute tubular necrosis: a forward analysis of 228 cases Nephron 51 307–313 Occurrence Handle2918941
F Liaño J Pascual (1996) ArticleTitleEpidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group Kidney Int 50 811–818 Occurrence Handle8872955
SH Hou DA Bushinsky JB Wish JJ Cohen JT Harrington (1983) ArticleTitleHospital-acquired renal insufficiency: a prospective study Am J Med 74 243–248 Occurrence Handle6824004 Occurrence Handle1:STN:280:DyaL3s7isVSntA%3D%3D Occurrence Handle10.1016/0002-9343(83)90618-6
CE Douma JHP Meulen ParticleVan der RT Krediet (1997) ArticleTitlePredicting mortality in intensive care patients with acute renal failure treated with dialysis J Am Soc Nephrol 8 111–117 Occurrence Handle9013455 Occurrence Handle1:STN:280:ByiC28rmvFA%3D
F Liaño J Pascual J Ortuño (1993) ArticleTitlePrognosis of acute tubular necrosis: an extended prospectively contrasted study Nephron 63 21–31 Occurrence Handle8446248 Occurrence Handle10.1159/000187139
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655
JY Fagon J Chastre A Novara P Medioni C Gilbert (1993) ArticleTitleCharacterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection Intensive Care Med 19 137–144 Occurrence Handle8315120 Occurrence Handle1:STN:280:ByyA3c7is1M%3D Occurrence Handle10.1007/BF01720528
JF Macias-Nunez JM Lopez-Novoa M Martinez-Maldonado (1996) ArticleTitleAcute renal failure in the aged Semin Nephrol 16 830–838
P Arora V Kher HS Kohli RK Sharma A Gupta R Jha (1993) ArticleTitleAcute renal failure in the elderly: experience in a single centre in India Nephrol Dial Transplant 8 827–830 Occurrence Handle8255515 Occurrence Handle1:STN:280:ByuD2sjksVU%3D
J Prakash RK Saxena OP Sharma Usha (2001) ArticleTitleSpectrum of renal diseases in the elderly. Single center experience from a developing country Int Urol Nephrol 33 227–233 Occurrence Handle12092635 Occurrence Handle1:STN:280:DC%2BD38zkvFynsg%3D%3D Occurrence Handle10.1023/A:1015279619491
Macias JF, Sanchez Tomero DA (1987) Acute renal failure in old people. In: Macias JF, Cameron JS (eds) Renal failure and disease in the elderly Butterworths, London, pp 461–484
R Kumar CM Hill MG McGeow (1973) ArticleTitleAcute renal failure in elderly Lancet 1 90–91 Occurrence Handle4118662 Occurrence Handle1:STN:280:CSyD28nitFE%3D Occurrence Handle10.1016/S0140-6736(73)90480-7
JE Romao Junior AR Haiashi AF Vidonho Junior H Abensur PS Quintaes MR Araujo IL Noronha FR Santos MM Machado (2000) ArticleTitleCauses and prognosis of acute renal failure in elderly patients Rev Assoc Med Bras 46 212–217 Occurrence Handle11070511 Occurrence Handle1:STN:280:DC%2BD3M7htV2lsQ%3D%3D
F Santacruz S Barreto MM Mayor W Cabrera N Breuer (1996) ArticleTitleMortality in elderly patients with acute renal failure Ren Fail 18 601–605 Occurrence Handle8875685 Occurrence Handle1:STN:280:ByiD38bmslE%3D
R Thadhani M Pascual JV Bonventre (1996) ArticleTitleAcute renal failure N Engl J Med 334 1448–1460 Occurrence Handle8618585 Occurrence Handle1:STN:280:BymB3MfotlQ%3D Occurrence Handle10.1056/NEJM199605303342207
F Bridoux M Hazzar JL Palloj (1992) ArticleTitleAcute renal failure after the use of angiotensin converting enzyme inhibitors in patients without renal artery stenosis Nephrol Dial Transplant 7 100–104 Occurrence Handle1314966 Occurrence Handle1:STN:280:By2B3snos1U%3D
R Sesso A Roque B Viciso S Stella (2004) ArticleTitlePrognosis of ARF in hospitalised elderly patients Am J Kidney Dis 44 410–419 Occurrence Handle15332213
J Pascual F Liano (1998) ArticleTitleCauses and prognosis of acute renal failure in the very old. The Madrid Acute Renal Failure Study Group J Am Geriatr Soc 46 721–725 Occurrence Handle9625188 Occurrence Handle1:STN:280:DyaK1c3os1ymsA%3D%3D
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Mahajan, S., Tiwari, S., Bhowmik, D. et al. Factors affecting the outcome of acute renal failure among the elderly population in India: a hospital based study. Int Urol Nephrol 38, 391–396 (2006). https://doi.org/10.1007/s11255-006-0053-y
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DOI: https://doi.org/10.1007/s11255-006-0053-y