Abstract
Acute kidney injury (AKI) is becoming increasingly common in elderly individuals. The presence of multiple comorbidities as well as age-related changes in the kidney, systemic vasculature and immunological system render older patients more prone to renal injury. Hypovolemia, sepsis, and iatrogenic complications related to drug toxicity, contrast-induced nephropathy, and perioperative complications therefore often occur in older hospitalized patients. Although AKI is treated in the same way in elderly individuals and younger patients, elderly individuals are more vulnerable to dialysis-related complications such as hemodynamic instability, bleeding, and mild disequilibrium syndrome. Strategies for the prevention of AKI are particularly important in these fragile patients, but making an early diagnosis is especially challenging in this age group.
Key Points
-
Elderly hospitalized patients are at high risk of developing acute kidney injury (AKI)
-
The increased risk of AKI in this patient group can be explained by age-related changes in the kidney, systemic vasculature, and immunological system, as well as frequent comorbidities and high exposure to iatrogenic insults such as medications, radiocontrast agents, and surgery
-
Early diagnosis of AKI is particularly important, but occult decreased renal function is common in elderly individuals, and serum creatinine is an unreliable marker of kidney function in these patients
-
Novel biomarkers show promise in achieving early diagnosis and prediction of outcomes for patients with AKI
-
Preventative measures are the most important part of AKI management
-
Renal replacement therapy is generally well tolerated and effective, but elderly individuals are prone to hypotension, bleeding, and subtle disequilibrium syndrome
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Politics of Aging: Government agencies and the aging network. http://www.trinity.edu/mkearl/ger-pol.html.
Schmitt, R. et al. Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am. J. Kidney Dis. 52, 262–271 (2008).
Redfern, S. J. & Ross, F. M. Nursing Older People, 3rd edn (eds Redfern, S. J. & Ross, F. M.) xi (Churchill Livingstone, Philadelphia, 1999).
Ricci, Z., Cruz, D. & Ronco, C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 73, 538–546 (2008).
United Nations Department of Economic and Social Affairs Population Division. World Population Ageing: 1950–2050 [online], (2001).
Nash, K., Hafeez, A. & Hou, S. Hospital-acquired renal insufficiency. Am. J. Kidney Dis. 39, 930–936 (2002).
Kohli, H. S. et al. Treatment-related acute renal failure in the elderly: a hospital-based prospective study. Nephrol. Dial. Transplant. 15, 212–217 (2000).
Baraldi, A. et al. Acute renal failure of medical type in an elderly population. Nephrol. Dial. Transplant. 13 (Suppl. 7), S25–S29 (1998).
Fliser, D. Ren sanus in corpore sano: the myth of the inexorable decline of renal function with senescence. Nephrol. Dial. Transplant. 20, 482–485 (2005).
Martin, J. E. & Sheaff, M. T. Renal ageing. J. Pathol. 211, 198–205 (2007).
Schmitt, R. & Cantley, L. G. The impact of aging on kidney repair. Am. J. Physiol. Renal Physiol. 294, F1265–F1272 (2008).
Bagshaw, S. M., George, C. & Bellomo, R. for the ANZICS database Management Committee. Early acute kidney injury and sepsis: a multicentre evaluation. Crit. Care 12, R47 (2008).
Pascual, J., Liaño, F. & Ortuño, J. The elderly patient with acute renal failure. J. Am. Soc. Nephrol. 6, 144–153 (1995).
Glen, S. K. & Boon, N. A. Coronary artery disease in the elderly. Rev. Clin. Gerontol. 9, 13–21 (1999).
Cheung, C. M., Ponnusamy, A. & Anderton, J. G. Management of acute renal failure in the elderly patient: a clinician's guide. Drugs Aging 25, 455–476 (2008).
Lameire, N. et al. Causes and prognosis of acute renal failure in elderly patients. Nephrol. Dial. Transplant. 2, 316–322 (1987).
Scolari, F. et al. Predictors of renal and patient outcomes in atheroembolic renal disease: a prospective study. J. Am. Soc. Nephrol. 14, 1584–1590 (2003).
Ronco, C., Haapio, M., House, A. A., Anavekar, N. & Bellomo, R. Cardiorenal syndrome. J. Am. Coll. Cardiol. 52, 1527–1539 (2008).
Newsome, B. B. et al. Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction. Arch. Intern. Med. 168, 609–616 (2008).
Sweileh, W., Sawalha, A., Al-Jabi, S. & Abaas, M. Discharge medications among ischemic stroke survivors. J. Stroke Cerebrovasc. Dis. 18, 97–102 (2009).
Chobanian, A. V. et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289, 2560–2572 (2003).
Carlsen, J. E., Kober, L., Torp-Pedersen, C. & Johansen, P. Relation between dose of bendrofluazide, antihypertensive effect, and adverse biochemical effects. BMJ 300, 975–978 (1990).
McCullough, P. A. et al. on behalf of the CIN Consensus Working Panel. Epidemiology and prognostic implications of contrast-induced nephropathy. Am. J. Cardiol. 98 (Suppl.), 5–13 (2006).
Swartz, R. D., Crofford, L. J., Phan, S. H. & Ike, R. W. Nephrogenic fibrosing dermopathy: a novel cutaneous fibrosing disorder in patients with renal failure. Am. J. Med. 114, 563–573 (2003).
Noor, S. & Usmani, A. Post operative renal failure. Clin. Geriatr. Med. 24, 721–729 (2008).
Alexander, K. P. et al. Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network. J. Am. Coll. Cardiol. 35, 731–738 (2000).
Feest, T. G., Round, A. & Hamad, S. Incidence of severe acute renal failure in adults: results of a community based study. BMJ 306, 481–483 (1993).
Ali, T. et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J. Am. Soc. Nephrol. 18, 1292–1298 (2007).
Hou, S. H., Bushinsky, D. A., Wish, J. B., Cohen, J. J. & Harrington, J. T. Hospital acquired renal insufficiency: a prospective study. Am. J. Med. 74, 243–248 (1983).
Pascual, J. & Liaño, F. Causes and prognosis of acute renal failure in the very old. Madrid Acute Renal Failure Study Group. J. Am. Geriatr. Soc. 46, 721–725 (1998).
Fontanarosa, P., Kaeberlein, F., Gerson, L. & Thomson, R. Difficulty in predicting bacteremia in elderly emergency patients. Ann. Emerg. Med. 21, 842–848 (1992).
Barrett, B. J. Contrast nephrotoxicity. J. Am. Soc. Nephrol. 5, 125–137 (1994).
Lautin, E. M. et al. Radiocontrast-associated renal dysfunction: incidence and risk factors. Am. J. Roentgenol. 157, 49–58 (1991).
Ellis, J. H. & Cohan, R. H. Prevention of contrast-induced nephropathy: an overview. Radiol. Clin. North Am. 47, 801–811 (2009).
Tezval, M. et al. Acute colonic pseudo-obstruction (Ogilvie's syndrome), a life-threatening complication after total hip replacement [German]. Zentralbl. Chir. 134, 263–266 (2009).
De Waele, J. J. & De Laet, I. Intra-abdominal hypertension and the effect on renal function. Acta Clin. Belg. Suppl. 2, 371–374 (2007).
Lameire, N. & Hoste, E. Reflections on the definition, classification, and diagnostic evaluation of acute renal failure. Curr. Opin. Crit. Care 10, 468–475 (2004).
Ohkawa, S. et al. Association of age with muscle mass, fat mass, and fat distribution in non-diabetic hemodialysis patients. Nephrol. Dial. Transplant. 20, 945–951 (2005).
Hirsh, S. Prerenal success in chronic kidney disease. Am. J. Med. 120, 754–759 (2007).
Soni, S., Ronco, C., Katz, N. & Cruz, D. N. Early diagnosis of acute kidney injury: the promise of novel biomarkers. Blood Purif. 28, 165–174 (2009).
Han, W. K., Bailly, V., Abichandani, R., Thadhani, R. & Bonventre, J. V. Kidney injury molecule-1 (KIM-1): a novel biomarker for human renal proximal tubule injury. Kidney Int. 62, 237–244 (2002).
Parikh, C. R., Jani, A., Melnikov, V. Y., Faubel, S. & Edelstein, C. L. Urinary interleukin-18 is a marker of human acute tubular necrosis. Am. J. Kidney Dis. 43, 405–414 (2004).
Nickolas, T. L. et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann. Intern. Med. 148, 810–819 (2008).
Fliser, D. & Ritz, E. Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am. J. Kidney Dis. 37, 79–83 (2001).
Shlipak, M. G. et al. Cystatin C and the risk of death and cardiovascular events among elderly persons. N. Engl. J. Med. 352, 2049–2060 (2005).
Hsieh, C. W. & Chen, H. H. Continuous renal replacement therapy for acute renal failure in the elderly. Int. J. Gerontology 1, 46–51 (2007).
Bonello, M., Petras, D., Ricci, Z., Zamperetti, N. & Ronco, C. Acute renal failure in the elderly critically ill patient. In Critical Care Nephrology (eds Ronco, C., Bellomo, R. & Kellum, J. A.) 1675–1680 (Saunders, Elsevier, Philadelphia, 2009).
Bagshaw, S. M., Polanco, N., Ocampo, C., Bellomo, R. & Davenport, A. Effect of renal replacement therapy on the brain. In Critical Care Nephrology (eds Ronco, C., Bellomo, R. & Kellum, J. A.) 1675–1680 (Saunders, Elsevier, Philadelphia, 2009).
Somogyi-Zalud, E., Zhong, Z., Hamel, M. B. & Lynn, J. The use of life-sustaining treatments in hospitalized persons aged 80 and older. J. Am. Geriatr. Soc. 50, 930–934 (2002).
Cosmos, A. Cost-effectiveness of providing quality ICU care to elderly patients. ICU Management 9, 6–7 (2009).
Robinson, T. N. et al. Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann. Surg. 250, 449–455 (2009).
De Biase, V. et al. Prolonged conservative treatment for frail elderly patients with end-stage renal disease: the Verona experience. Nephrol. Dial. Transplant. 23, 1313–1317 (2008).
Dasta, J. F., Kane-Gill, S. L., Durtsch, A. J., Pathak, D. S. & Kellum, J. A. Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol. Dial. Transplant. 23, 1970–1974 (2008).
Chertow, G. M. et al. Acute kidney injury, mortality, length of stay and costs in hospitalized patients. J. Am. Soc. Nephrol. 16, 3365–3370 (2005).
Macedo, E., Bouchard, J. & Mehta, R. L. Renal recovery following acute kidney injury. Curr. Opin. Crit. Care 14, 660–666 (2008).
Ishani, A. et al. Acute kidney injury increases risk of ESRD among elderly. J. Am. Soc. Nephrol. 20, 223–228 (2009).
Schiffl, H. The pathogenesis of acute kidney injury may differ between elderly and younger patients. Am. J. Kidney Dis. 52, 1198–1199 (2009).
Hsu, C. Y. et al. The risk of acute renal failure in patients with chronic kidney disease. Kidney Int. 74, 101–107 (2008).
Lindeman, R. D., Tobin, J. & Shock, N. W. Longitudinal studies on the rate of decline in renal function with age. J. Am. Geriatr. Soc. 33, 278–285 (1985).
Rowe, J. W., Andres, R., Tobin, J. D., Norris, A. H. & Shock, N. W. The effect of age on creatinine clearance in man: a cross-sectional and longitudinal study. J. Gerontol. 31, 155–163 (1976).
Iseki, K., Kinjo, K., Iseki, C. & Takishita, S. Relationship between predicted creatinine clearance and proteinuria and the risk of developing ESRD in Okinawa, Japan. Am. J. Kidney Dis. 44, 806–814 (2004).
Acknowledgements
Désirée Lie, University of California, Orange, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Chronopoulos, A., Cruz, D. & Ronco, C. Hospital-acquired acute kidney injury in the elderly. Nat Rev Nephrol 6, 141–149 (2010). https://doi.org/10.1038/nrneph.2009.234
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrneph.2009.234
This article is cited by
-
Incidence, risk factors and outcomes of acute kidney injury in surgical intensive care unit octogenarians at the Jordan University Hospital
BMC Geriatrics (2023)
-
Incidence of hospital-acquired acute kidney injury and trajectories of glomerular filtration rate in older adults
BMC Nephrology (2023)
-
Role of platelet to albumin ratio for predicting persistent acute kidney injury in patients admitted to the intensive care unit
BMC Anesthesiology (2023)
-
Risk factors for acute kidney injury after major abdominal surgery in the elderly aged 75 years and above
BMC Nephrology (2022)
-
Effects of the diagnostic window and duration of acute kidney injury on 1-year mortality in elderly patients: a single-center retrospective study
International Urology and Nephrology (2022)