Introduction: Older people in community are susceptible to acute kidney injury (AKI) and hemodialysis is the most important supportive measure used in the management of severe AKI. This study aims to investigate the clinical characteristics, outcomes and risk factors for mortality in older patients with dialysis-receiving-community-acquired AKI (CA-AKI).
Methods: A total of 1953 CA-AKI patients aged 65 years old and above were recruited from 2013 to 2016. Among which, 200 patients received hemodialysis. Clinical characteristics, outcomes, suspected nephrotoxic drug use after CA-AKI and risk factors for mortality in older CA-AKI patients with dialysis were analyzed.
Results: The percentage of CA-AKI patients receiving hemodialysis was 10.2%. Compared with non-dialysis patients, dialysis-receiving patients had more comorbidity, and worse renal function. The types of suspected nephrotoxic drugs used in dialysis patients were more than those in non-dialysis patients. Moreover, dialysis-receiving patients had worse outcomes, including complete recovery of renal function (42.0% vs 71.6%), intensive care unit (ICU) (69.0% vs 15.3%) transfer and in-hospital mortality (50.5% vs 5.6%) (P< 0.01). Age, moderate/severe liver disease, beta lactam antibiotics, glycopeptide antibiotics, antifungal agents, drugs for anti-heart failure, category of suspected nephrotoxic drugs, hyperkalemia, increased leucocyte count, ICU transfer, multiple organ dysfunction (MODS), cardiogenic shock and cardio-pulmonary resuscitation (CPR) were risk factors for mortality by univariate logistic regression analysis. After adjusting for confounding factors, the independent risk factors were glycopeptide antibiotics, drugs for anti-heart failure, ICU transfer, MODS and CPR.
Conclusion: The percentage of older CA-AKI patients receiving dialysis was high, and these patients had more comorbidity and worse prognosis. Glycopeptide antibiotics, drugs for anti-heart failure, ICU transfer, MODS and CPR were independent risk factors for mortality.

Keywords: community-acquired acute kidney injury, older people, dialysis, outcome, risk factors for mortality


中文翻译：

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接受透析的社区获得性急性肾损伤老年患者死亡的临床特征和危险因素

简介：社区老年人易患急性肾损伤（AKI），血液透析是治疗严重 AKI 最重要的支持措施。本研究旨在调查老年透析社区获得性 AKI (CA-AKI) 患者的临床特征、结局和死亡风险因素。
方法： 2013-2016年共招募65岁及以上CA-AKI患者1953例，其中血液透析200例。分析了老年 CA-AKI 透析患者的临床特征、结果、CA-AKI 后疑似肾毒性药物的使用以及死亡的危险因素。
结果：CA-AKI 患者接受血液透析的比例为 10.2%。与非透析患者相比，接受透析的患者合并症较多，肾功能较差。透析患者使用的疑似肾毒性药物种类多于非透析患者。此外，接受透析的患者结局更差，包括肾功能完全恢复（42.0% vs 71.6%）、重症监护病房（ICU）（69.0% vs 15.3%）转移和住院死亡率（50.5% vs 5.6%） (磷< 0.01)。年龄、中度/重度肝病、β-内酰胺类抗生素、糖肽类抗生素、抗真菌剂、抗心力衰竭药物、疑似肾毒性药物类别、高钾血症、白细胞计数增加、ICU 转移、多器官功能障碍 (MODS)、心源性休克和通过单因素逻辑回归分析，心肺复苏术（CPR）是死亡的危险因素。调整混杂因素后，独立危险因素为糖肽类抗生素、抗心力衰竭药物、ICU转移、MODS和CPR。
结论：接受透析的老年 CA-AKI 患者比例较高，这些患者合并症较多，预后较差。糖肽类抗生素、抗心力衰竭药物、ICU转移、MODS和CPR是死亡的独立危险因素。

关键词：社区获得性急性肾损伤，老年人，透析，结果，死亡危险因素