Kidney Week

Abstract: TH-PO021

Predictors for AKI in Old Age

Session Information

• AKI: Epidemiology, Risk Factors, Prevention
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Ebert, Natalie, Charité Universitaetsmedizin Berlin, Berlin, Germany

Natalie Ebert,

• Huscher, Doerte, Charité Universitätsmedizin Berlin, Berlin, Germany

Doerte Huscher,

• Gaedeke, Jens, Dept. of Nephrology, Charité, Berlin, Germany

Jens Gaedeke,

• van der Giet, Markus, Dept. of Nephrology, Charité, Berlin, Germany

Markus van der Giet,

• Kuhlmann, Martin K., Vivantes Klinikum im Friedrichshain, Berlin, Germany

Martin K. Kuhlmann,

• Mielke, Nina, Charité Universitaetsmedizin Berlin, Berlin, Germany

Nina Mielke,

• Schaeffner, Elke, Charité Universitaetsmedizin Berlin, Berlin, Germany

Elke Schaeffner,

Group or Team Name

• Berlin Initiative Study (BIS)

Background

Acute kidney injury (AKI) is a feared condition especially in old age. Data on incidence rates however as well as predictors are scarce. The Berlin Initiative Study (BIS) evaluates the incidence of AKI and potential predictors in older adults.

Methods

The BIS is a prospective population-based cohort initiated in 2009 whose participants are members of a German insurance company with the largest fraction of older adults. Patients are documented biannually by a standardized questionnaire. All intermediate hospitalizations with referral and acute ICD-10 (N17.xx) diagnoses were provided by the insurance company. N17.xx events during hospitalizations were identified. From the group without incident AKI 16 patients with prevalent events were excluded. Multivariate Cox-PH regression analysis was used to detect predictors for the first incident AKI.

Results

As of May 04, 2018, 2053 participants (47.4% male, mean age 80.3 at inclusion) were observed for 7.4±0.4 years. Of those, 189 (9.2%) experienced at least one AKI during the observation. In total, 292 events were observed (incidence ratio / 100.000 person-yrs: 1900). At baseline, patients with incident AKI were about 2.4 years older, more frequently male (57 vs. 47%), had a worse waist-hip-ratio (WHR, median 1.0 vs. 0.9), eGFR_(BIS2) (median 49 vs. 60 mL/min per 1.73m²) and albumin-creatinine ratio (median 17 vs. 10 mg/g) and suffered more often from comorbidities at baseline (hypertension 91 vs. 77%, diabetes 40 vs. 25%, myocardial infaction 22.0 vs 13%, stroke 15 vs. 8%, anemia 32 vs. 16%). Of the 189 patients with AKI, 26 (13.8%) were admitted to the hospital with an N17.xx ICD-10 code, all other patients with other primary referral diagnoses; the median number of hospitalization during the observation period was 7 (median duration of stay 11 days). Of the patients without AKI, 41% had hospitalizations with a median number of 4 (median duration of 7.6 days).
In the multivariate model, eGFR_(BIS2) (OR=0.873 [0.83;0.92] per 5 units), waist-hip-ratio (OR=1.47 [1.24;1.74] per 0.1 units), hypertension (OR=2.00 [1.18;3.38]), diabetes (OR=1.61 [1.19;2.18]), and anemia (OR=1.52 [1.09;2.12]) were predictive for AKI in older adults.

Conclusion

With 1900 per 100.000 person-yrs AKI is frequent in a representative sample ≥70 yrs. Potential predictors apart from eGFR_(BIS2) were WHR, hypertension, diabetes and anemia.

Funding

• Veterans Affairs Support