Treatment-related acute renal failure in the elderly: a hospital-based prospective study.
BACKGROUND
Elderly individuals need a host of diagnostic procedures and therapeutic interventions to take care of ailments. This prospective study was carried out to determine the magnitude of treatment-related acute renal failure (ARF) in the elderly in a hospital setting, to know about pathogenetic factors and to study the factors that could predict an adverse outcome.


METHODS
All elderly patients (>60 years) admitted over a 12-month period were screened prospectively throughout their hospital stay for the development of ARF.


RESULTS
Of 31860 patients admitted, 4176 (13%) were elderly. Of these 59 (1.4%) developed ARF in the hospital. Nephrotoxic drugs contributed towards development of ARF in 39 (66%), sepsis and hypoperfusion in 27 (45.7%) each, contrast medium in 10 (16.9%) and postoperative ARF occurred in 15 (25.4%) patients. These pathogenetic factors were responsible for ARF in different combinations. Amongst these combination of pathogenetic factors, radiocontrast administration (partial chi(2) 28.1, P<0.0001), surgery (partial chi(2) 14.89, P=0.001), and drugs (partial chi(2) 6. 22, P=0.0126) predicted ARF on their own. Nine patients (15.23%) needed dialytic support. Of 59 patients, 15 (25.4%) died, of those who survived, 38 (86.3%) recovered renal function completely and six (13.6%) partially. Mortality in the elderly with ARF was significantly higher than in those without ARF (25.4 vs 12.5%; chi(2) 8.3, P=0.03). Sepsis (odds ratio 43), oliguria (odds ratio 64), and hypotension (odds ratio 15) were independent predictors of poor patient outcome on logistic regression analysis.


CONCLUSIONS
Incidence of treatment-related ARF in the elderly was 1.4%, with more than one pathogenetic factor playing a role in the development of ARF in the majority. Sepsis, hypotension, and oliguria were the independent predictors of poor patient outcome.
Kohli
H S
HS
Departments of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Bhaskaran
M C
MC
Muthukumar
T
T
Thennarasu
K
K
Sud
K
K
Jha
V
V
Gupta
K L
KL
Sakhuja
V
V
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000150:complications / Q000209:etiology* / Q000401:mortality; D000368:Aged; D000375:Aging / Q000502:physiology*; D003287:Contrast Media / Q000009:adverse effects; D005544:Forecasting; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000150:complications; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D007239:Infections / Q000150:complications; D008875:Middle Aged; D009846:Oliguria / Q000150:complications; D011183:Postoperative Complications; D011446:Prospective Studies
D003287:Contrast Media