Epidemiology and outcomes of acute kidney injury in elderly chinese patients: a subgroup analysis from the EACH study.
BACKGROUND
Information on acute kidney injury (AKI) in elderly hospitalized patients is limited. This study aims to assess the incidence, risk factors and outcomes of AKI in elderly Chinese patients.


METHODS
The Epidemiology of AKI in Chinese Hospitalized adults (EACH) study is a multicenter, retrospective cohort study conducted in nine regional central hospitals across China. Patients aged more than 65 years were selected from the EACH study for this analysis. A novel approach with adjustment for frequency of serum creatinine was used to estimate the incidence of AKI in elderly patients. In-hospital outcomes, including mortality, renal recovery, length of stay and daily cost of elderly patients, were analyzed and compared with outcomes in younger patients.


RESULTS
Of 144,232 adult patients in the EACH study, 42,737 (29.63 %) patients were 65 years or older, including 9773 very elderly patients (≥80 years old). The incidence of AKI was 15.44 % in patients 65-79 years old (community-acquired (CA) AKI of 3.89 % and hospital-acquired (HA) AKI of 11.55 %) and 22.22 % in the very elderly group (CA-AKI of 6.58 % and HA-AKI of 15.64 %). The mortality rate of AKI was 10.3 % in patients aged from 65 to 80 and 19.6 % in patients older than 80 years. AKI incidence, in-hospital mortality, percentage of patients requiring dialysis and percentage without renal recovery were higher in elderly patients than in younger patients.


CONCLUSIONS
The incidence of AKI in elderly Chinese hospitalized patients is high, which becomes a substantial burden on medical care in China.
Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, China.
Shuwang
S
Ge
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Sheng
S
Nie
The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
Zhangsuo
Z
Liu
Guangdong General Hospital, Guangzhou, China.
Chunbo
C
Chen
Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China.
Yan
Y
Zha
Huashan Hospital, Fudan University, Shanghai, China.
Jing
J
Qian
Zhongda Hospital, Southeast University, Nanjing, China.
Bicheng
B
Liu
The Second Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, China.
Siyuan
S
Teng
Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Anping
A
Xu
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Wei
W
Bin
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Xin
X
Xu
Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, China. xugang@tjh.tjmu.edu.cn.
Gang
G
Xu
Acute kidney injury; Chinese; Elderly; Epidemiology; Outcomes
Lancet. 2015 Oct 10;386(10002):1465-71
26466051
J Am Soc Nephrol. 2011 Jan;22(1):28-38
21209252
J Am Soc Nephrol. 2010 Feb;21(2):345-52
20019168
J Am Soc Nephrol. 2013 Jan;24(1):37-42
23222124
Lancet. 2015 Jan 10;385(9963):117-71
25530442
J Chin Med Assoc. 2013 May;76(5):271-6
23683260
Am J Kidney Dis. 2008 Aug;52(2):262-71
18511164
Clin J Am Soc Nephrol. 2010 Jul;5(7):1330-9
20498247
Clin J Am Soc Nephrol. 2013 Sep;8(9):1482-93
23744003
Am J Kidney Dis. 2011 Aug;58(2):206-13
21496979
Nat Rev Nephrol. 2014 Apr;10(4):193-207
24445744
Arch Gerontol Geriatr. 2012 Mar-Apr;54(2):e47-51
21684023
Ren Fail. 2014 Sep;36(8):1273-7
24986184
Am J Kidney Dis. 2015 Jun;65(6):860-9
25488106
J Nephrol. 2012;25 Suppl 19:S48-57
22505250
J Nephrol. 2013 May-Jun;26(3):572-9
22641583
Crit Care. 2013 Oct 13;17(5):R234
24119730
JAMA. 2005 Aug 17;294(7):813-8
16106006
Injury. 2012 Sep;43(9):1470-5
21144512
Clin J Am Soc Nephrol. 2015 Sep 4;10(9):1510-8
26231194
Lancet. 2016 May 14;387(10032):2017-25
27086173