Advertisement

Dialysis Options for the Elderly Patient with Acute Kidney Injury

  • Mitchell H. RosnerEmail author
Chapter
  • 635 Downloads

Abstract

Acute kidney injury (AKI) is a common and serious event that most often complicates hospitalization for serious illness [1]. Recent data demonstrates that from 2000 to 2009, the incidence of dialysis-requiring AKI increased from 222 to 533 cases per million person-years, an average increase of 10 % per year [2]. An important factor driving this increase in AKI over the past decade is the older age of the population, which serves as an independent risk factor for the development of AKI. It is now clear that the elderly are at the very highest risk for the development of AKI, and over the past 25 years, the mean age of patients with AKI has increased by at least 5 years and perhaps as much as 15 years [3]. In a large European cohort of patients, the average age of patients with AKI was 76 years [4]. Hsu et al. most recently also demonstrated that not only were elderly patients at higher risk for the most severe form of AKI (that requires dialysis) as compared to younger patients, but that over time the incidence of AKI in the elderly is increasing more rapidly than in younger cohorts [2]. At the more severe extremes of AKI, hospitalized patients with dialysis-requiring AKI are older than their counterparts without dialysis-requiring AKI (63.4 versus 47.6 years) [2].

Keywords

Elderly Hemodialysis Peritoneal dialysis Outcomes 

References

  1. 1.
    Lamiere N, Van Biesen W, Vanholder R (2008) Acute kidney injury. Lancet 372:1863–1865CrossRefGoogle Scholar
  2. 2.
    Hsu RK, McCulloch CE, Dudley RA et al (2012) Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol 24:37–42, epub December 6, 2012CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Turney JH, Marshall DH, Brownjohn AM, Ellis CM, Parsons FM (1990) The evolution of acute renal failure, 1956–1988. Q J Med 74:83–104PubMedGoogle Scholar
  4. 4.
    Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W et al (2007) Incidence and outcome in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol 18:1292–1298CrossRefPubMedGoogle Scholar
  5. 5.
    Chronopoulos A, Rosner MH, Cruz DN, Ronco C (2010) Acute kidney injury in elderly intensive care patients: a review. Intensive Care Med 36:1454–1464CrossRefPubMedGoogle Scholar
  6. 6.
    Schmitt R, Coca S, Kanbay M et al (2008) Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis 52:262–271CrossRefPubMedGoogle Scholar
  7. 7.
    Wald R, Quinn RR, Luo J et al (2009) Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 302:1179–1185CrossRefPubMedGoogle Scholar
  8. 8.
    Uchino S, Kellum JA, Bellomo R et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818CrossRefPubMedGoogle Scholar
  9. 9.
    Pascual J, Liano F (1998) Causes and prognosis of acute renal failure in the very old. Madrid Acute Renal Failure Study Group. J Am Geriatr Soc 46:721–725CrossRefPubMedGoogle Scholar
  10. 10.
    Gong Y, Zhang F, Ding F, Gu Y (2012) Elderly patients with acute kidney injury (AKI): clinical features and risk factors for mortality. Arch Gerontol Geriatr 54:e47–e51CrossRefPubMedGoogle Scholar
  11. 11.
    Coca SG, King JT Jr, Rosenthal RA, Perkal MF, Parikh CR (2010) The duration of postoperative acute kidney injury is an additional parameter predicting long-term survival in diabetic veterans. Kidney Int 78:926–933CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Morgera S, Kraft AK, Siebert G, Luft FC, Neumayer HH (2002) Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies. Am J Kidney Dis 40:275–279CrossRefPubMedGoogle Scholar
  13. 13.
    de Mendonca A, Vincent JL, Suter PM et al (2000) Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 26:915–921CrossRefPubMedGoogle Scholar
  14. 14.
    Renal physician association shared decision making in the appropriate initiation of and withdrawal from dialysis, 2nd ed. Available at: http://www.renalmd.org/catalogue-item.aspx?id=682. Accessed 30 Jan 2013
  15. 15.
    Palevsky P (2013) Renal replacement therapy in acute kidney injury. Adv Chronic Kid Dis 20:76–84CrossRefGoogle Scholar
  16. 16.
    Karvellas CJ, Farhat MR, Sajjad I et al (2011) A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care 15:R72CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bouchard J, Sorroko SB, Chertow GM et al (2009) Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 76:422–427CrossRefPubMedGoogle Scholar
  18. 18.
    Lins RL, Elseviers MM, Ven de Niepen P et al (2009) Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial. Nephrol Dial Transplant 24:512–518CrossRefPubMedGoogle Scholar
  19. 19.
    Vinsonneau C, Camus C, Combes A et al (2006) Continuous venovenous hemodiafiltration versus intermittent hemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome : a multicenter randomized trial. Lancet 368:379–385CrossRefPubMedGoogle Scholar
  20. 20.
    Rabindranath K, Adams J, Macleod AM, Muirhead N (2007) Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev 3, CD003773PubMedGoogle Scholar
  21. 21.
    Bagshaw SM, Berthiaume LR, Delaney A, Bellomo R (2008) Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis. Crit Care Med 36:610–617CrossRefPubMedGoogle Scholar
  22. 22.
    Group KDIGOKAKIW (2012) KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl 2:1–138CrossRefGoogle Scholar
  23. 23.
    Davenport A (2009) Continuous renal replacement therapies in patients with acute neurological injury. Semin Dial 22:165–168CrossRefPubMedGoogle Scholar
  24. 24.
    Lenk MR, Kaspar M (2012) Sodium-reduced continuous venovenous hemodiafiltration (CVVHDF) for the prevention of central pontine myelinolysis (CPM) in hyponatremic patients scheduled for orthotopic liver transplantation. J Clin Anesth 24:407–411CrossRefPubMedGoogle Scholar
  25. 25.
    Phu NH, Hien TT, Mai NY et al (2002) Hemofiltration and peritoneal dialysis in infection-associated acute renal failure in Vietnam. N Engl J Med 347:895–902CrossRefPubMedGoogle Scholar
  26. 26.
    Gabriel DP, Caramori JT, Martin LC et al (2009) Continuous peritoneal dialysis compared with daily hemodialysis in patients with acute kidney injury. Perit Dial Int 29(Suppl 2):S62–S71PubMedGoogle Scholar
  27. 27.
    Ghaffari A (2012) Urgent-start peritoneal dialysis: a quality improvement report. Am J Kidney Dis 59:400–408CrossRefPubMedGoogle Scholar
  28. 28.
    Schiffl H, Lang SM, Fischer R (2002) Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 346:305–310CrossRefPubMedGoogle Scholar
  29. 29.
    Faulhaber-Walter R, Hafer C, Jahr N et al (2009) The Hannover Dialysis Outcome Study: comparison of standard versus intensified extended dialysis for treatment of patients with acute kidney injury in the intensive care unit. Nephrol Dial Transplant 24:2179–2186CrossRefPubMedGoogle Scholar
  30. 30.
    Ronco C, Bellomo R, Homel P et al (2000) Effects of different doses in continuous veno-venous hemofiltration on outcomes of acute renal failure: a prospective randomized trial. Lancet 356:26–30CrossRefPubMedGoogle Scholar
  31. 31.
    Bellomo R, Cass A, Cole L et al (2009) Intensity of continuous renal replacement therapy in critically ill patients. N Engl J Med 361:1627–1638CrossRefPubMedGoogle Scholar
  32. 32.
    Palevsky PM, Zhng JH, O’Connor TZ et al (2008) Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 359:7–20CrossRefPubMedGoogle Scholar
  33. 33.
    Fissell WH (2013) Antimicrobial dosing in acute renal replacement. Adv Chronic Kidney Dis 20:85–93CrossRefPubMedGoogle Scholar
  34. 34.
    Davenport A, Mehta S (2002) The acute dialysis quality initiative- part VI. Access and anticoagulation in CRRT. Adv Renal Replace Ther 9:273–281CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Division of NephrologyUniversity of Virginia Health SystemCharlottesvilleUSA

Personalised recommendations