Factores predictores de fracaso renal agudo en ancianos con enfermedad renal crónica / Acute renal failure predictors in elderly patients with chronic kidney disease

Introducción y objetivos: El fracaso renal agudo (FRA) es un problema muy común en los ancianos y conlleva una elevada morbimortalidad. En este estudio se analizan los factores predictores de FRA en una cohorte de ancianos y su impacto en la evolución de la función renal. Pacientes y métodos: Sobre un grupo de 80 ancianos reclutados entre enero-abril de 2006, se estudian de forma retrospectiva, en 56 pacientes que continúan con vida a los 36 meses, los episodios de FRA, sus causas y la necesidad de diálisis. Resultados: 12 pacientes (21,4 %) presentaron FRA: 4 (33,3 %) con relación a insuficiencia cardiaca, 4 (33,3 %) por infección/sepsis, 2 (16,7 %) por depleción de volumen y otros 2 multifactorial (16,7 %). Ningún paciente precisó terapia con diálisis. Los pacientes con FRA eran más añosos (p = 0,017), tenían basalmente peor función renal (p = 0,031), mayores niveles de ácido úrico (p = 0,002) y menores de hematocrito (p = 0,003). Los pacientes con FRA tenían una creatinina sérica basal de 1,57 ± 0,59 mg/dl y el pico máximo de creatinina durante el FRA fue de 4,25 ± 4,26 mg/dl (p = 0,035). La función renal a los 36 meses en pacientes con FRA había disminuido (p = 0,024). En el análisis de regresión logística (variables independientes: edad, género, índice de (..) (AU)

Introduction: Acute renal failure (ARF) is a very common problem in the elderly and is associated with high morbidity and mortality rates. This study analysed ARF predictors in a cohort of elderly subjects and their impact on the evolution of renal function. Patients and method: A group of 80 elderly individuals were recruited between January and April 2006, and 56 of these who were still alive after 36 months were retrospectively studied, examining episodes of ARF, their causes, and the need for dialysis. Results: Twelve patients (21.4%) developed ARF: 4 (33.3%) related to heart failure, 4 (33.3%) due to infection/sepsis, 2 (16.7%) due to volume depletion, and another 2 were multifactorial (16.7%). No patients required dialysis therapy. Patients with ARF were older (P=.017), had worse renal function at baseline (P=.031), higher levels of uric acid (P=.002), and lower haematocrit (P=.003). Patients with ARF had a mean baseline serum creatinine of 1.57±0.59mg/dl and peak creatinine levels during episodes of ARF averaged 4.25±4.26mg/dl (P=.035). Mean renal function at 36 months in patients with ARF had decreased (P=.024). In a logistic regression analysis (independent variables: baseline MDRD, age, gender, Charlson index, serum creatinine, urea, and uric (..) (AU)

Acute renal failure predictors in elderly patients with chronic kidney disease.

INTRODUCTION: Acute renal failure (ARF) is a very common problem in the elderly and is associated with high morbidity and mortality rates. This study analysed ARF predictors in a cohort of elderly subjects and their impact on the evolution of renal function. PATIENTS AND METHOD: A group of 80 elderly individuals were recruited between January and April 2006, and 56 of these who were still alive after 36 months were retrospectively studied, examining episodes of ARF, their causes, and the need for dialysis. RESULTS: Twelve patients (21.4%) developed ARF: 4 (33.3%) related to heart failure, 4 (33.3%) due to infection/sepsis, 2 (16.7%) due to volume depletion, and another 2 were multifactorial (16.7%). No patients required dialysis therapy. Patients with ARF were older (P=.017), had worse renal function at baseline (P=.031), higher levels of uric acid (P=.002), and lower haematocrit (P=.003). Patients with ARF had a mean baseline serum creatinine of 1.57 ± 0.59 mg/dl and peak creatinine levels during episodes of ARF averaged 4.25 ± 4.26 mg/dl (P=.035). Mean renal function at 36 months in patients with ARF had decreased (P=.024). In a logistic regression analysis (independent variables: baseline MDRD, age, gender, Charlson index, serum creatinine, urea, and uric acid), age (RR: 1.20, 1.01-1.43, P=.039), uric acid (RR: 2.65, 1.11-6.30, P=.027), and haematocrit (RR: 0.64, 0.43-0.96, P=.031) were independently associated with the development of ARF. CONCLUSIONS: Baseline levels of uric acid and haematocrit are independent risk factors for the development of ARF in the elderly. Although these episodes may be functional in nature and not require dialysis, this can still cause a deterioration of renal function over time.

Ancianos con enfermedad renal crónica: ¿qué ocurre a los cinco años de seguimiento? / Elderly patients with chronic kidney disease: outcomes after 5 years of follow-up

Introducción: En los últimos años, la enfermedad renal crónica (ERC) se ha llegado a considerar una epidemia, por lo que se ha prestado un gran interés a su diagnóstico precoz, con la finalidad de frenar su progresión a nefropatía terminal (NT) y preparar con tiempo a los pacientes para programas de diálisis y trasplante. Muchos ancianos son etiquetados de enfermos renales crónicos basándose únicamente en un filtrado glomerular estimado < 60 ml/min. Objetivo: realizar un seguimiento clínico de la función renal (FR) y de los pronósticos asociados a la ERC (morbilidad, mortalidad, desarrollo de NT) en ancianos. Pacientes y métodos: 80 pacientes clínicamente estables con mediana de edad de 83 años (rango 69-97); 69% mujeres, 35% diabéticos, 83% hipertensos; fueron reclutados aleatoriamente en las consultas externas de Geriatría y Nefrología entre enero y abril de 2006, y seguidos durante 5 años. En el reclutamiento establecimos dos grupos según la concentración de creatinina plasmática (Crp) basal (mg/dl): grupo 1: 38 pacientes con Crp ≤ 1,1 (rango 0,7-1,1) y grupo 2: 42 pacientes, con Crp > 1,1 (rango 1,2-3). Medimos en sangre Crp, urea, y estimamos filtrado glomerular con MDRD abreviado, basalmente y a los 5 años. Registramos la comorbilidad basal (..) (AU)

Introduction: In recent years, chronic kidney disease (CKD) has come to be considered an epidemic problem, and there is considerable interest in early diagnosis in order to slow its progression to end-stage renal disease (ESRD) and prepare patients for dialysis and transplantation programmes. Many elderly patients are labelled as having CKD based solely on having a glomerular filtration rate (GFR) of <60 ml/min. Objective: Monitor renal function (RF) and outcomes associated with CKD (morbidity, mortality and progress to ESRD) in an elderly cohort. Patients and method: A total of 80 clinically stable patients, with a median age of 83 years (range 69-97; 69% female, 35% diabetic, 83% hypertensive) were recruited at random in our Geriatric Medicine and Nephrology Departments between January and April 2006, and monitored for 5 years. During the recruitment stage we established two groups based on baseline serum creatinine (SCr) concentration: Group 1, 38 patients with SCr <1.1mg/dl (range 0.7-1.1) and Group 2, 42 patients with SCr >1.1mg/dl (range 1.2-3). We determined baseline blood levels of creatinine and urea, calculated eGFR using an abbreviated Modification of Diet in Renal Disease (..) (AU)

Elderly patients with chronic kidney disease: outcomes after 5 years of follow-up.

INTRODUCTION: In recent years, chronic kidney disease (CKD) has come to be considered an epidemic problem, and there is considerable interest in early diagnosis in order to slow its progression to end-stage renal disease (ESRD) and prepare patients for dialysis and transplantation programmes. Many elderly patients are labelled as having CKD based solely on having a glomerular filtration rate (GFR) of <60 ml/min. OBJECTIVE: Monitor renal function (RF) and outcomes associated with CKD (morbidity, mortality and progress to ESRD) in an elderly cohort. PATIENTS AND METHOD: A total of 80 clinically stable patients, with a median age of 83 years (range 69-97; 69% female, 35% diabetic, 83% hypertensive) were recruited at random in our Geriatric Medicine and Nephrology Departments between January and April 2006, and monitored for 5 years. During the recruitment stage we established two groups based on baseline serum creatinine (SCr) concentration: Group 1, 38 patients with SCr <1.1mg/dl (range 0.7-1.1) and Group 2, 42 patients with SCr >1.1mg/dl (range 1.2-3). We determined baseline blood levels of creatinine and urea, calculated eGFR using an abbreviated Modification of Diet in Renal Disease (MDRD) formula, and repeated these measurements after 5 years. We recorded baseline comorbidity according to the Charlson comorbidity index (CCI); hospital admissions; new cardiovascular events; treatments; progression to ESRD requiring dialysis; and mortality. RESULTS: In the 39 patients surviving after 5 years there were no significant differences between Groups 1 and 2 in total number of hospital admissions, episodes of heart failure and new ischaemic heart disease. Overall, the most commonly used drugs were diuretics (76.9%), while beta-blockers were used the least (10.3%). There were 41 deaths (51.3%): of these patients, 15 died due to overall decline, 8 due to infections, 4 due to stroke, 4 due to neoplasia, 3 due to cardiovascular problems, 2 due to complications from fractures and 5 due to unknown causes. Mortality was higher in Group 2 (66.7% vs 34.2%, P=.004) and patient age was also higher in that group (84.73 ± 5.69 vs 80.12 ± 6.5, P=.001). No significant differences in mortality were attributable to sex, diabetes, hypertension or CCI. Only 2 patients in Group 2 progressed to ESRD, they received conservative treatment due to comorbidity (no patients in the study have started dialysis). The evolution of RF (baseline/5 years) in all patients surviving at 5 years was as follows: SCr (mg/dl): 1.15 ± 0.41/1.21 ± 0.49 (not significant [NS]), urea (mg/dl) 52.21 ± 13.0/61.21 ± 27.0 (P=.047), MDRD (ml/min/1.73m2) 57.47 ± 15/54.86 ± 17 (NS). There were no differences in progression between the 2 groups. In the logistic regression analysis for overall mortality (independent variables: age, sex, CCI, cardiovascular history, SCr and group), only age (relative risk [RR]: 1.12; 1.03-1.23, P=.009) and group (RR: 3.06; 1.10-8.40, P=.031) were independently associated with mortality. CONCLUSION: Screening for CKD using GFR only may lack clinical relevance in this population since RF slowly deteriorates in elderly patients without proteinuria. Mortality due to all causes was higher in elderly patients with a poorer baseline RF, and mortality rates were higher than rates of CKD progression to ESRD.