Is acute kidney injury age-dependent in older adults: an observational study in two centers from North China

Libin Xu, Yanhua Wu, Yuanhan Chen, Ruiying Li, Zhiqiang Wang, Zhilian Li, Guoping Liu, Lei Yu, Wei Shi, Xinling Liang, China collaborative study on AKI (CCS-AKI), Libin Xu, Yanhua Wu, Yuanhan Chen, Ruiying Li, Zhiqiang Wang, Zhilian Li, Guoping Liu, Lei Yu, Wei Shi, Xinling Liang, China collaborative study on AKI (CCS-AKI)

Abstract

Background: Although aging increases susceptibility to acute kidney injury (AKI), whether the AKI risk and the association between AKI and adverse outcomes are age-dependent remain unclear in older adults. The current study aimed to identify whether AKI risk was age-dependent in older adults and to investigate whether the association between AKI and mortality increased with increasing age.

Methods: Medical records from 47,012 adult hospital admissions, including 30,194 older adults aged 60 or older, in two tertiary general hospitals were studied retrospectively. AKI was identified based on changes in blood creatinine levels according to the Kidney Disease: Improving Global Outcomes criteria.

Results: Among the total population and 30,194 older adult patients, the raw incidences of AKI were 8.2 and 8.3%, respectively. The curve of the age-grouped AKI incidence was "U-shaped", which revealed a positive relationship between the AKI incidence and age among the older adults aged 75 years or older. This trend of the age-AKI relationship was supported by further multivariable analysis. After adjusting for the Charlson Comorbidity Index score, the AKI was associated with in-hospital mortality; however, the associations did not increase with increasing age.

Conclusion: The AKI risk does not increase with age in older adults, except for those aged 75 and above. The association between AKI and in-hospital death did not increase in an age-dependent manner in older adults.

Trial registration: This study was retrospectively registered at clinicaltrials.gov ( NCT03054142 ) on February 13, 2017.

Keywords: Creatinine; Epidemiological study; Geriatric acute kidney injury; Hospitalized population; Mortality; Older adults.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The raw incidence of AKI along an age gradient
Fig. 2
Fig. 2
Risk of AKI stratified by age Black dots and error bars denote the odds ratios of the risk of AKI and its 95% confidence intervals compared with the reference age, 45–74 years. The dashed line denotes an odds ratio of 1.0. Included variables selected into the multivariable logistic regression model by the forward logistic regression (LR) method were eGFR stratification, hypertension, diabetes mellitus, myocardial infarction, peripheral angiopathy, cerebrovascular disease and heart failure.
Fig. 3
Fig. 3
Risk of in-hospital mortality in the older adults stratified by age Black dots and error bars denote the odds ratios and 95% confidence intervals of the mortality risk for patients with AKI compared with non-AKI patients. The dashed line denotes an odds ratio of 1.0. The mortality risk associated with AKI was adjusted for the Charlson Comorbidity Index.

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