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The increase in life expectancy, the prevalence of chronic comorbidities, and access to healthcare have been leading clinicians to focus on the needs of an older population group. Nephrology monitoring of hospitalized elderly populations has gradually increased over the years, whether due to Acute Kidney Injury (AKI) or Chronic Kidney Disease (CKD). The characteristics associated with mortality in this population are still unknown."
This is a retrospective study, in which data was collected from electronic medical records of patients over 80 years old admitted to the “Hospital do Servidor Público do Estado de São Paulo” from January 2022 to July 2023, with impaired renal function and who were followed up by the nephrology service. The patients were monitored by the nephrology service during hospitalization until hospital discharge or death. Laboratorial and clinical data were analyzed until the outcome of each patient. In a population of 609 patients, we conducted an analysis to examine the characteristics associated with the outcomes of mortality or hospital discharge using bimodal logistic regression.
In the evaluated population, 338 (55,6%) patients were discharged from hospital, and 271 (44.4%) patients died. In the group that was discharged from the hospital, the nephrology team was called earlier compared to the other group (3 days, range 1-7 vs. 2 days, range 1-5; p=0.004). Regarding the Charlson comorbidity index, a lower score was a predictor of better outcomes during hospitalization and a greater chance of progression to hospital discharge (7 score, range 6-8.5 vs. 7 score, range 6-8; p<0.001), as well as obstruction being the etiology of AKI (26 patients, 9.6% vs. 66 patients, 19.5%; p=0.034). Sepsis and shock as causes of AKI, along with the need for mechanical ventilation, were independent variables associated with a higher risk of death (197 cases, 72.7% vs. 180 cases, 53.3%; p=0.001; 75 cases, 27.7% vs. 4 cases, 1.2%; p=0.002; 116 cases, 42.8% vs. 10 cases, 3%; p<0.001; respectively). Dialysis in this group was also associated with higher mortality (91 cases, 33.6% vs. 37 cases, 10.9%; p=0.025).
In agreement with data obtained in previous studies, dialysis in this group was also associated with higher mortality. When dealing with individuals over 80 years of age with hospitalized AKI or CKD, nephrologists must take into account the specific factors linked to poor prognosis when making clinical decisions.