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Abstract: FR-PO095

The Risk of AKI in the Elderly With Advanced CKD

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Goulamhoussen, Nadir, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Bouchard, Josee, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Pelletier, Karyne, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Chapdelaine, Isabelle, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Troyanov, Stephan, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
Background

AKI in the elderly is associated with short- and long-term mortality, increased risk of ESKD, and functional decline. Estimating the incidence of AKI in advanced CKD is challenging, given that the 0.3 mg/dl threshold might not be of clinical significance. Using the KDIGO definitions, we assessed AKI frequency and recovery time in the elderly with advanced CKD as well as its predictors.

Methods

We included all patients ≥ 70 years of age and followed for ≥3 months at the Sacré-Coeur kidney protection clinic from 2012 to 2020. All AKI episodes, defined by an increase of 0.3 mg/dL over 48 hours or 1.5x increase over 7 days during the follow-up period were recorded. Given the elevated baseline creatinine, we also identified subpopulations of patients who also reached 0.5 and 1.0 mg/dL elevation in creatinine. We assessed differences between age groups. AKI recovery was defined as a return to within 0.3 mg/dL from baseline, within 2 or 7 days.

Results

We included 462 patients, of which 46 % were female, with an initial eGFR of 20 ± 8 mL/min/1.73m2, and followed for a median of 21 [9-38] months. The rate of AKI was 36 events/100 patient-years, with 39 % experiencing at least one episode. AKI incidence was similar across age strata (Table), but recovery using the 1.5x criteria in those ≥ 90 years was lower (43 % vs. 79 %, p = 0.04). CKD etiologies were not associated with the risk or recovery of AKI. Predisposing risk factors of AKI were a history of congestive heart failure (26 % vs. 13 %, p = 0.005) and liver disease (44 % vs 15 %, p = 0.02).

Conclusion

AKI frequency is elevated in the elderly with severe CKD, with an increased risk of non-recovery in the very old.

Age groups at 1st assessment (n)70-79 (182)80-89 (239)≥ 90 (41)
AKI (%)   
- No AKI616163
- ↑ creat ≥ 0.3 mg/dL within 48h6.0112.4
- ↑ creat ≥ 0.3 mg/dL within 48h, with peak ≥ 0.5 mg/dL107.512
- ↑ creat ≥ 0.3 mg/dL within 48h, with peak ≥ 1 mg/dL7.14.64.9
- ↑ creat ≥ 1.5x baseline within 7 days151617
Time to recovery within <0.3 mg/dL (%)   
- ≤ 2, [2-7], ≥7 days, no recovery18, 21, 42, 1822, 23, 36, 200, 27, 47, 27

Funding

  • Private Foundation Support