Age may help protect against incident kidney failure with replacement therapy
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Key takeaways:
- Patients aged 65 to 74 years with AKI had the highest risk for kidney failure with replacement therapy.
- Patients older than 85 years with AKI had the lowest risk.
Age may work as a protective factor against incident kidney failure with replacement therapy but not against death, according to results from a national cohort study of U.S. veterans.
“Advanced age is a major risk factor for the development of [chronic kidney disease] CKD, which has high heterogeneity in disease progression,” Danira Medunjanin, PhD, of the Ralph H. Johnson VA Medical Center in Charleston, South Carolina, wrote with colleagues. They added, “Previous AKI epidemiologic analyses have focused on hospitalized populations, which may bias results toward sicker populations.”
Researchers evaluated 24,133 veterans, aged 65 years or older, who had incident CKD stage 4 from 2011 to 2013. Investigators used data from the Veterans Health Administration Corporate Data Warehouse for the cohort study. The goal was to find the link between AKI, age and the risk of developing kidney failure with replacement therapy (KFRT) in older adults with advanced CKD.
The study found no significant age interaction between AKI and KFRT. However, researchers found a “clinically relevant combined impact” of AKI and age on incident KFRT.
Patients aged 65 to 74 years with AKI had the highest risk for KFRT with a HR of 14.9, compared to the oldest age group without AKI, according to the findings. Patients aged 85 years or older with AKI, by contrast, had the lowest with a 1.71 HR.
Researchers found the risk of death increased 44% once veterans had KFRT. KFRT risk doubled across all AKI severity stages, while the risk of death escalated with worse AKI severity.
“This is likely explained by the high frequency of deaths observed in this population,” of 51.1%, according to the researchers. They added, “Though death was far more frequent than KFRT in this population, our national cohort study showed that the combined impact of AKI and age is a substantial risk factor for incident KFRT in older U.S. veterans with advanced CKD.”
Health providers should consider “preventative measures such as more frequent visits to nephrology care to mitigate the observed poor prognoses associated with AKI in older adults with preexisting CKD,” they wrote.
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