Abstract:

Objective  To investigate the characteristics and treatment of acute kidney injury (AKI) of senile patients. Methods  A total of 150 cases of AKI treated from January 2009 to December 2014 were retrospectively analyzed. All cases accorded with the diagnosis criteria of AKI of KDIGO. Accompanied diseases, severity of diseases, and 60-day fatality rate of patients older than 80 years and younger than 60 years were compared. Biochemical indexes and blood pressure of patients before and after blood purification were monitored and risk factors of mortality of two groups were analyzed. Results  Among 150 patients, 91 of them were older than 80 years (senile group) with average age of (88.6±5.0) years and 59 of them were younger than 60 years (adult group) with average age of (44.3±12.6) years. Accompanied diseases of the senile group were primary hypertension, coronary heart disease, and diabetes mellitus, while those of the adult group were acute or chronic nephritis, malignant tumor, systemic autoimmunity disease, and obstructive nephropathy. And 27.1% of patients of the adult group did not have any accompanied diseases. Diseases of the senile group were severer than those of the adult group. APACHE Ⅲ scores, rate of medical ventilation, and the incidence of sepsis, hypotension, and MODS of the senile group were significantly higher than those of the adult group (P<0.001). In the senile group, 94.5% of patients underwent bedside slow low-efficiency daily dialfiltration (SLEDD-f) therapy, while 93.2% of patients of the adult group accepted intermediate hemodialysis (IHD). The differences of systolic and diastolic pressures between two groups before treatment were statistically significant, but after blood purification, the differences between two groups were not statistically significant. The serum creatinine and HCO₃^- levels within the group before and after treatment were significantly different. The 60-day fatality rate of the senile group was 65.9%, which was significantly higher than that of the adult group (30.5%, P＜0.01). The risk factors of mortality of two groups were APPECH Ⅲ scores, MODS, and age. Conclusion  Diseases of senile patients with AKI were severer than those of the adult patients and the fatality rate of senile patients was higher due to decreased renal function and more accompanied diseases. Comprehensive treatment is more suitable for senile patients with complications and unstable hemodynamic indexes.

Key words: acute kidney injury, senile patients, bedside slow low-efficiency daily dialfiltration, hemodialysis