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Hospital-acquired acute kidney injury in the elderly

Nature Reviews Nephrology volume 6, pages 141–149 (2010)Cite this article

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Abstract

Acute kidney injury (AKI) is becoming increasingly common in elderly individuals. The presence of multiple comorbidities as well as age-related changes in the kidney, systemic vasculature and immunological system render older patients more prone to renal injury. Hypovolemia, sepsis, and iatrogenic complications related to drug toxicity, contrast-induced nephropathy, and perioperative complications therefore often occur in older hospitalized patients. Although AKI is treated in the same way in elderly individuals and younger patients, elderly individuals are more vulnerable to dialysis-related complications such as hemodynamic instability, bleeding, and mild disequilibrium syndrome. Strategies for the prevention of AKI are particularly important in these fragile patients, but making an early diagnosis is especially challenging in this age group.

Key Points

  • Elderly hospitalized patients are at high risk of developing acute kidney injury (AKI)

  • The increased risk of AKI in this patient group can be explained by age-related changes in the kidney, systemic vasculature, and immunological system, as well as frequent comorbidities and high exposure to iatrogenic insults such as medications, radiocontrast agents, and surgery

  • Early diagnosis of AKI is particularly important, but occult decreased renal function is common in elderly individuals, and serum creatinine is an unreliable marker of kidney function in these patients

  • Novel biomarkers show promise in achieving early diagnosis and prediction of outcomes for patients with AKI

  • Preventative measures are the most important part of AKI management

  • Renal replacement therapy is generally well tolerated and effective, but elderly individuals are prone to hypotension, bleeding, and subtle disequilibrium syndrome

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Figure 1: Perioperative acute kidney injury.

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Acknowledgements

Désirée Lie, University of California, Orange, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Department of Nephrology, San Bortolo Hospital and International Research Institute of Vicenza, Viale Rodolfi 37, Vicenza, 36100, Italy

    Alexandra Chronopoulos, Dinna N. Cruz & Claudio Ronco

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Correspondence to Claudio Ronco.

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Chronopoulos, A., Cruz, D. & Ronco, C. Hospital-acquired acute kidney injury in the elderly. Nat Rev Nephrol 6, 141–149 (2010). https://doi.org/10.1038/nrneph.2009.234

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