Age-Dependent Effects of Acute Kidney Injury on End-Stage Kidney Disease and Mortality in Patients with Moderate to Severe Chronic Kidney Disease

Yu-Hsiang Chou; Tai-Shuan Lai; Yi-Chih Lin; Wen-Chih Chiang; Tzong-Shinn Chu; Shuei-Liong Lin; Yung-Ming Chen

doi:10.1159/000528021

Age-Dependent Effects of Acute Kidney Injury on End-Stage Kidney Disease and Mortality in Patients with Moderate to Severe Chronic Kidney Disease

Nephron. 2023;147(6):329-336. doi: 10.1159/000528021. Epub 2023 Jan 17.

Authors

Yu-Hsiang Chou¹, Tai-Shuan Lai¹, Yi-Chih Lin^{1

2

3}, Wen-Chih Chiang¹, Tzong-Shinn Chu¹, Shuei-Liong Lin^{1

4

5

6}, Yung-Ming Chen¹

Affiliations

¹ Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan.
² Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan.
³ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁴ Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
⁶ Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.

PMID: 36649699
DOI: 10.1159/000528021

Abstract

Introduction: Old age has been considered as a positive modifier of chronic kidney disease (CKD), but the progression of CKD is often accelerated by acute kidney injury (AKI) in older adults. This study aimed to investigate this paradoxical interplay and identify age-specific predictors of end-stage kidney disease (ESKD).

Methods: This retrospective cohort included 6,101 patients with CKD stage 3B-5 followed at a single center during 2005-2018. Participants were stratified into four age groups to explore age-dependent influences on the risk of ESKD and all-cause mortality. Multivariate Cox proportional hazard regression model with competing risk analysis was used to identify predictors of outcomes.

Results: During a median follow-up of 2.68 years, 1,650 (27.0%) patients developed ESKD and 541 (8.9%) patients died. The rate of ESKD decreased with advancing age, being lowest in the very old-aged (>75 years) group who displayed the slowest rate of estimated glomerular filtration rate (eGFR) decline. Multivariate Cox proportional hazard regression adjusted for competing death showed that younger ages, compared with patients aged >75 years, together with AKI episodes and several traditional risk factors were identified as predictors for ESKD. The impact of AKI episodes on ESKD development was most prominent in patients aged >75 years. These results were confirmed with subgroup analyses in patients with outcomes of different ages.

Conclusion: Older adults with CKD exhibited a slower decline rate of eGFR, yet they were more likely to develop ESKD following AKI episodes. These results suggest tackling AKI is needed to prevent accelerated initiation of renal replacement therapy in elderly patients with pre-existing CKD.

Keywords: Acute kidney injury; Chronic kidney disease; Elderly patients; End-stage kidney disease; Mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury*
Aged
Disease Progression
Glomerular Filtration Rate
Humans
Kidney Failure, Chronic* / therapy
Middle Aged
Renal Insufficiency, Chronic* / therapy
Retrospective Studies
Risk Factors