Acute kidney injury in elderly patients

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Material and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

Do Muslims Living in Poland Approve of Organ Transplantation?

BACKGROUND Although the International Society for Islamic Legal Studies and the Islamic Organization for Medical Sciences have officially approved of transplantations, Muslims' opinions on this issue are not uniform. The aim of this study was to assess the general knowledge, attitudes, and opinions concerning organ transplantation among Muslim Tatars living in North-East Poland. MATERIAL AND METHODS The study included 78 Muslim Tatars and was carried out at the Center of Muslim Culture using the diagnostic poll method. RESULTS Transplantation from living donors was accepted by 96.1% of respondents, and from dead donors by 88.8% of respondents. Consent to the removal of organs after the death of a close relative was approved of by 57.7%, and 1/5 of respondents objected to it. Removal of their organs after death was approved of by 70.5% of respondents, more often by persons with higher education and vocational education than among those with only elementary education. Only 2.2% of respondents had reported their objection to the Central Objection Register. Almost 40% of men and women informed their family members about their willingness to be an organ donor. Most (71.8%) respondents had a positive attitude to transplantation, 25.6% had a negative attitude, and 2.6% were neutral. Approximately 72% of respondents believed that the final decision concerning the removal of organs from dead donors should be made by the family, and according to 8.9%, it should be prescribed by the law. CONCLUSIONS Muslim Tatars living in Poland mostly accept the removal of organs both from live donors and from dead bodies. Gender and education level had a considerable impact on the decision concerning organ donation.

Vitamin D deficiency and anemia is highly prevalent and dependent on the etiology of heart failure: A pilot study.

BACKGROUND: Anemia and vitamin D deficiency are common factors in chronic heart failure (CHF). The aim of this study was to assess vitamin D levels as well as its binding protein and anemia in relation to a cause of CHF: coronary heart disease, valvular disease and cardiomyopathy. METHODS: One hundred and sixteen consecutive patients (36 females and 80 males) with CHF were admitted for percutaneous coronary interventions (PCI). Hemoglobin concentration, serum creatinine, B-type natriuretic peptide (BNP), 25-hydroxyvitamin D [25(OH)D] and its binding protein-VDBP were measured. RESULTS: The prevalence of anemia was 22%. BNP was the highest in the group with coronary artery disease. Ejection fraction was the lowest in cardiomyopathy group. 25(OH)D was lowest in valvular disease group, significantly lower than in the coronary artery group. A similar pattern of change showed vitamin D binding protein. The prevalence of vitamin D deficiency (level below 20 ng/mL) in the whole group was 95%, in 49% of the patients 25(OH)D was below 10 ng/mL. In univariate analysis 25(OH)D correlated with hemoglobin, red blood cell count, hematocrit, mean corpuscular volume and BNP in patients with CHF in the whole group. In multiple regression analysis, predictors of 25(OH)D were estimated, glomerular filtration rate, BNP and valvular disease. CONCLUSIONS: 25(OH)D deficiency is common in CHF patients. Valvular disease is associated the most severe vitamin D deficiency and worsened kidney function. A higher prevalence of anemia in CHF due to coronary heart disease may be associated with wider use of angiotensin converting enzyme inhibitors and acetylsalicylic acid. Heart and kidney function are predictors of 25(OH)D level in the patients of this study.

Early outcomes and long-term survival after kidney transplantation in elderly versus younger recipients from the same donor in a matched-pairs analysis.

ABSTRACT: The elderly are the fastest-growing population on waiting lists for kidney transplantation (KTx). Recognized barriers to KTx in the elderly is early post-transplant mortality and morbidity. To analyze the outcomes of KTx in recipients older than 60 years and, simultaneously, in their younger paired recipients, receiving a graft from the same donor.We included 328 kidney transplant recipients in the study. The elderly kidney transplant recipients (EKT) group included 164 patients aged 65 standard deviation (SD4) years. They were paired with younger kidney transplant recipients (YKT) aged 45 (SD12) years.The studied groups (EKT vs YKT) did not differ from the graft function estimated 1 year after the transplantation (50.7 mL/min vs 54.0 mL/min), while the estimated glomerular filtration rate decline was significantly faster in the YKT group. One-year patient survival (93.9% vs 97.0%), 1-year graft survival (90.4% vs 82.3%), and incidences of delayed graft function and acute rejection did not differ between the EKT and YKT groups. Significantly more cardiovascular complications and post-transplant diabetes mellitus were noticed in the EKT group. The long-term patient and graft survivals were poorer in the EKT group versus the YKT group, but death-censored graft survivals were the same. After having excluded donor-derived graft factors, there were no differences in the first-year outcome of KTx between recipients younger and older than 60 years. As life expectancy is lower in the EKT group, the probability of patient and graft survival was also significantly lower in this group. However, death-censored graft survival was not different in the EKT and YKT groups.

Opinions of Followers of Judaism Residing in the Northeastern Part of Poland on Organ Donation.

BACKGROUND: Families of deceased potential donors often object to organ harvesting on religious grounds. The aim of this study was to learn the attitudes and opinions of Judaism followers regarding organ donation. MATERIAL AND METHODS: The study included 97 Judaism followers living in the northeastern part of Poland. The research used the diagnostic survey method. RESULTS: A fairly large percentage (approximately 92%) of respondents accepted treatment using organ transplantation. The removal of organs for transplantation from a loved one after his death was accepted by about 90%. After his death, 14.43% expressed opposition to organ removal. About one-third of respondents did not talk to the family about their organ donation attitude. The average age of people who talked to their family about their will to donate was 49.69 ± 13.95 years. In total, 91.75% of the respondents had a positive attitude toward organ transplantation, 6.19% negative, and 2.06% indifferent. According to respondents, the most common reasons for a family's refusal to collect organs from the deceased are death-related emotions (53.61%), religious beliefs (36.08%), and fear of misuse of organs (22.68%). CONCLUSION: Judaism believers mostly accept treatment with organs taken from living and deceased people. In a larger percentage, young people with higher and secondary education more often accepted organ donation.

Opinions and knowledge about organ donation and transplantation of residents of selected villages in Podlaskie Voivodeship.

BACKGROUND: In recent years, transplantation, a specific area of medicine, has achieved more and more support and acceptance among different nations around the world. However, there are still many ethical, moral, and legal barriers related to this form of treatment of end-stage organ failures. The aim of this study was to investigate the knowledge and opinions of rural residents about organ transplantation. MATERIAL AND METHODS: The research method is a diagnostic survey of 395 rural residents of selected villages of the region of Podlasie, located in north-east Poland. The research tool used to carry out the study was the authors' questionnaire. RESULTS: Organs procurement and transplantation from deceased donors are accepted by 72.6% of respondents. About 60% of the respondents would agree to organ donation for transplantation from the members of their family after death and 65.3% of the residents would be donors after their death. Half of the respondents (55.9%) believe that the final decision as to the donation of organs from a deceased person should be taken by the family. A positive attitude towards organ transplantation was expressed by 67.6% of respondents. CONCLUSIONS: Inhabitants of rural areas mostly agree with procurement of organs from the deceased and also from living donors. However, the enthusiasm and goodwill associated with the transplantation of organs after death diminished when the problem affects members of the family. Positive attitude about transplantation is related to age and level of the education.

Midkine: a novel and early biomarker of contrast-induced acute kidney injury in patients undergoing percutaneous coronary interventions.

We tested the hypothesis whether midkine could represent an early biomarker of contrast-induced acute kidney injury (CIAKI) in 89 patients with normal serum creatinine undergoing PCI. Midkine, serum and urinary NGAL, and cystatin C were evaluated before and 2, 4, 8, 24, and 48 hours after PCI using commercially available kits. Serum creatinine was assessed before and 24 and 48 hours after PCI. We found a significant rise in serum midkine as early as after 2 hours (P < 0.001) when compared to the baseline values. It was also significantly higher 4 hours after PCI and then returned to the baseline values after 24 hours and started to decrease after 48 hours. When contrast nephropathy was defined as an increase in serum creatinine by >25% of the baseline level 48 hours after PCI, the prevalence of CIN was 10%. Patients with CIN received significantly more contrast agent (P < 0.05), but durations of PCI were similar. Midkine was significantly higher 2, 4, and 8 hours after PCI in patients with CIN. Since the "window of opportunity" is narrow in CIAKI and time is limited to introduce proper treatment after initiating insult, particularly when patients are discharged within 24 hours after the procedure, midkine needs to be investigated as a potential early marker for renal ischemia and/or nephrotoxicity.

Angiographically-derived SYNTAX score and its prognostic value in dialysis patients: comparison with the Khan index.

BACKGROUND: The aim of this study was to assess the value of the angiographically-derived Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score in predicting mortality and major adverse cardiac events (MACEs) during a 3-year follow-up of dialysis patients undergoing a percutaneous coronary intervention or coronary artery bypass graft operation. We compared the aforementioned results with the clinical Khan index. METHODS: The SYNTAX score was calculated for 87 of 110 dialysis patients after coronary angiography. RESULTS: The mean SYNTAX score was 12.75 ± 14.49. During the 3-year follow-up, 58% of the patients died, and 74% had at least 1 MACE. In a Kaplan-Meier survival analysis, the risk of death and MACEs increased in parallel with the SYNTAX score. A score greater than 12.75 was strongly associated with mortality and MACE (both Ps < 0.01). In receiver operating characteristic (ROC) curve analysis, the areas under the curves (AUCs) of the SYNTAX score and Khan index were significantly higher (both Ps < 0.001) than the area of diagnostic indifference. The predictive values for death as indicated by the SYNTAX score and the Khan index, respectively, were almost identical in the ROC analysis (AUC SYNTAX score, 0.6436; AUC Khan index, 0.6475; P = 0.9532). Areas under the ROC curves of both methods according to MACE were also significantly different from those for the random model (both Ps < 0.001). CONCLUSIONS: The SYNTAX score is a powerful predictor of mortality and MACEs in dialysis patients undergoing percutaneous coronary intervention or coronary artery bypass graft during a 3-year follow-up. The score provides prognostic information similar to that provided by the Khan index.

New parameters in iron metabolism and functional iron deficiency in patients on maintenance hemodialysis.

INTRODUCTION: Iron metabolism has been studied for many years. New substances involved in iron metabolism continue to be described. Functional iron deficiency (FID) is characterized by the presence of adequate iron stores (as defined by standard criteria) but insufficient iron mobilization required for erythropoiesis during administration of erythropoiesis-stimulating agents. OBJECTIVES: The aim of the study was to evaluate new parameters of iron metabolism and the prevalence of FID as well as to assess potential correlations in patients on hemodialysis (HD). PATIENTS AND METHODS: The study included 98 patients on maintenance HD. Standard laboratory methods were used to measure the iron status, complete blood count, creatinine, calcium, phosphorus, albumin, intact parathyroid hormone, and lipids. Commercially available kits were used to measure high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), tumor necrosis factor-α, N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor (GDF15), bone morphogeneticprotein (BMP6), hemojuvelin, and hepcidin. RESULTS: FID was present in 23% of the patients on HD and was associated with significantly higher serum ferritin, IL-6, hsCRP, hepcidin, and NT-proBNP levels. There were no significant differences in BMP6 and GDF15 levels between patients with and without FID. Patients on HD had increased prevalence of hypertension, diabetes, and left ventricular hypertrophy and required slightly, but insignificantly, higher erythropoietin doses. Predictors of FID included serum iron levels and residual renal function. CONCLUSIONS: FID is present in a substantial proportion of patients on HD, who thus should be screened for reversible causes of inflammation. New parameters in iron metabolism do not seem to be related to FID in patients on HD.

Markers of kidney function in the elderly in relation to the new CKD-EPI formula for estimation of glomerular filtration rate.

INTRODUCTION: Neutrophil gelatinase-associated lipocalin (NGAL) has been recently proved useful in the quantitation of chronic kidney disease (CKD). The aim of the study was to assess prevalence of CKD according to the Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae in 412 patients with normal serum creatinine and markers of kidney function/injury such as NGAL, cystatin C, and kidney injury molecule-1 (KIM-1) in these patients in relation to age (below and over 65 years). MATERIAL AND METHODS: We included in the study 1005 patients with coronary artery disease and normal serum creatinine. However, markers of kidney function/injury were assessed in 412 patients. The NGAL, cystatin C and KIM-1, were assessed using commercially available kits. RESULTS: Patients over 65 years had significantly lower estimated glomerular filtration rate (eGFR) than their younger counterparts despite identical creatinine. They also had significantly lower haematocrit, despite similar Hb, lower platelet count, higher serum fibrinogen, higher systolic (SBP) and lower diastolic blood pressure, higher serum NGAL and cystatin C, but similar urinary NGAL and KIM-1. Serum NGAL correlated with age, haematocrit, leukocyte, platelet and erythrocyte count, eGFR, creatinine, fasting glucose, HbA(1c), fibrinogen, SBP, and diabetes duration. In multiple regression analysis kidney function (eGFR, creatinine clearance or creatinine), cystatin C and SBP were predictors of serum NGAL. CONCLUSIONS: In our study we found a very high prevalence of CKD up to 61% in elderly patients with coronary artery disease and normal serum creatinine. Neutrophil gelatinase-associated lipocalin could be a sensitive marker of kidney function, particularly in elderly patients with another risk factor for kidney damage, i.e. hypertension.

[Cardiovascular risk factors in dialyzed patients]. / Czynniki ryzyka chorób ukladu sercowo-naczyniowego u chorych dializowanych.

Cardiovascular complications are the main cause of mortality and morbidity among patients on dialyses. The aim of the work was to assess the effect of the type of renal replacement therapy on the risk factors and cardiovascular complication in dialyzed patients. The studies were performed retrospectively on 90 hemodialyzed and 49 peritoneally dialyzed patients. Risk factors of cardiovascular diseases as well as serum lipids, complete blood count, serum albumin, fibrinogen, C-reactive protein, calcium, phosphates, PTH, systolic, diastolic, mean blood pressure, left ventricular hypertrophy. Hemodialyzed patients were more anemic, longer on renal replacement therapy, with higher albumin, phosphates, lower fibrinogen, cholesterol, LDL, triglycerides, calcium, systolic and diastolic blood pressure than peritoneally dialyzed patients. Left ventricular hypertrophy more frequently found in hemodialyzed patients than in peritoneally dialyzed patients. In peritoneally dialyzed patients glucose load into the peritoneum, dyslipidemia and hiperfibrinogenemia may further contribute at the cardiovascular complications. In hemodialyzed patients anemia, left ventricular hypertrophy and ischemic heart disease is more frequent than in peritoneally dialyzed patients.