Clinical outcomes of acute kidney injury developing outside the hospital in elderly.

PURPOSE: Although various studies have improved our knowledge about the clinical features and outcomes of acute kidney injury developing in the hospital (AKI-DI) in elderly subjects, data about acute kidney injury developing outside the hospital (AKI-DO) in elderly patients (age ≥ 65 years) are still extremely limited. This study was performed to investigate prevalence, clinical outcomes, hospital cost and related factors of AKI-DO in elderly and very elderly patients. METHODS: We conducted a prospective, observational study in patients (aged ≥ 65 years) who were admitted to our center between May 01, 2012, and May 01, 2013. Subjects with AKI-DO were divided into two groups as "elderly" (group 1, 65-75 years old) and "very elderly" (group 2, >75 years old). Control group (group 3) consisted of the hospitalized patients aged 65 years and older with normal serum creatinine level. In-hospital outcomes and 6-month outcomes were recorded. Rehospitalization rate within 6 months of discharge was noted. Hospital costs and mortality rates of each group were investigated. Risk factors for AKI-DO were determined. RESULTS: The incidence of AKI-DO that required hospitalization in elderly and very elderly patients was 5.8 % (136/2324) and 11 % (100/905), respectively (p < 0.001), with an overall incidence of 7.3 % (236/3229). Chronic kidney disease (CKD) was developed in 43.4 % of group 1 and 67 % of group 2 within the 6 months of discharge (p < 0.001). Progression to CKD was significantly lower in the control group than in groups 1 and 2 (p < 0.001). Mortality rates for groups 1, 2 and 3 were 23.5 % (n = 32), 31 % (n = 31) and 4.2 % (n = 8), respectively (p < 0.05). Rehospitalization rate within the 6 months of discharge for the groups with AKI-DO was higher than for the control group (p < 0.001). Hospital cost of groups 1 and 2 was significantly higher than that of the control group (p < 0.001). Nonsteroidal anti-inflammatory drugs (NSAIDs) (OR: 6.839, 95 % CI = 4.392-10.648), angiotensin-converting enzyme inhibitors (ACEI) (OR: 7.846, 95 % CI = 5.161-11.928), angiotensin receptor blockers (ARB) (OR: 6.466, 95 % CI = 4.813-8.917), radiocontrast agents (OR: 8.850, 95 % CI = 5.857-13.372), hypertension (OR: 4.244, 95 % CI = 2.729-6.600), diabetes mellitus (OR: 2.303, 95 % CI = 1.411-3.761), heart failure (OR: 3.647, 95 % CI = 2.276-5.844) and presence of infection (OR: 3.149, 95 % CI = 1.696-5.845) were found as the risk factors for AKI-DO in elderly patients (p < 0.001 for all). Patients with AKI-DO had higher 6-month mortality rate (HR 1.721, 95 % CI: 1.451-2.043, p < 0.001). Mortality risk increased 0.519 times at 20th day. CONCLUSIONS: The incidence of AKI-DO requiring hospitalization is higher in very elderly patients than elderly ones, especially in male gender. Use of ACEI, ARB, NSAID and radiocontrast agents is the main risk factors for the development of AKI-DO in the elderly.

Community-acquired hypokalemia in elderly patients: related factors and clinical outcomes.

PURPOSE: Electrolyte imbalance is a common problem affecting the elderly. Increased number of comorbidities and frequent use of drugs may contribute to increased risk of hypokalemia in the elderly. This study was performed to investigate the prevalence of community-acquired hypokalemia (CAH), risk factors for its development, related factors with hypokalemia, and morbidities and all-cause mortality rates (MR) of CAH in the elderly patients. METHODS: Total of 36,361 patients aged above 65 years were screened retrospectively. Group 1 consisted of 269 elderly patients with potassium level ≤3.5 mmol/L, and group 2 (control group) consisted of 182 subjects with potassium level between 3.6 and 5.5 mmol/L. Etiologic factors of CAH, presence of comorbidities, duration of hospital stay, hospital cost, and clinical outcomes were recorded. RESULTS: Prevalence of hypokalemia was found 3.24% in patients aged above 65 years. Duration of hospital stay, presence of ≥2 comorbid diseases, hospital cost, and MR were significantly higher in group 1 compared to group 2 (p < 0.001 for all). Loop diuretics, hydrochlorothiazides, beta agonists, inadequate oral intake, and female gender were all independent risk factors for CAH in elderly patients. Patients with ≥2 comorbid diseases were found to have greater risk of hypokalemia than the patients with <2 comorbidities. CONCLUSIONS: Length of hospital stay, hospital cost, and MR were higher in elderly with CAH. Female gender, hydrochlorothiazides, loop diuretics, and ≥2 comorbid diseases are the leading risk factors associated with CAH in elderly.

Recurrent Acute Kidney Injury in Renal Transplant Patients: A Single-Center Study.

OBJECTIVE: Renal transplant patients may have recurrent episodes of acute kidney injury (AKI) during the posttransplant period. Determination and management of risk factors may help to prevent recurrence of AKI and allograft loss. In this study, we investigated the clinical features of renal transplant patients with recurrent AKI and evaluated etiologies and risk factors. MATERIALS AND METHODS: A total of 19 patients with 79 AKI episodes were examined retrospectively. AKI classes, etiologies, and risk factors were investigated. Their features were compared with 38 renal transplant patients without AKI. RESULTS: Distribution of AKI episodes according to the type of injury was as follows: 15 prerenal, 43 renal, 6 postrenal, and 15 mixed. Renal transplant patients with recurrent AKI had a greater duration of dialysis before transplantation (P < .05). Logistic regression analysis revealed no predictor for recurrent AKI after renal transplantation. Infections participated in the development of 45 AKI episodes. Chronic kidney disease developed in 16 patients. CONCLUSION: Infections are the leading condition associated with recurrent AKI in renal transplant patients. Recurrent AKI may contribute to the development and progression of chronic kidney injury.

How do we measure blood pressure at home?

BACKGROUND: Home blood pressure monitoring (HBPM) is one of the measures that increases compliance with antihypertensive therapy. HBPM requires a proper measurement technique as well as an accurate sphygmomanometer. The aim of this study was to assess the characteristics of home sphygmomanometers (HS) in a big city in Turkey. SUBJECTS AND METHOD: We assessed the HS of hypertensive patients (n = 452; male: 253, female: 199) who were examined for the first time in our outpatient center. General evaluation of HS included trademark, model, device's age, cuff size, validation and calibration status. RESULTS: We interviewed 452 patients and 452 HS were identified. The most common factors affecting the patients' choice for the type and model of the HS were its simplicity and ease of use (28.2%), followed by advertisements (44%), physician's advice (19.3%) and the belief in accurate measurement (< 1%). All patients were unaware of validation and calibration of their devices. CONCLUSION: Awareness of both patients and physicians about the validation status of HS is not enough. Some complaints from patients may be associated with using non-validated HS. There is a need for a policy or standard criteria for HS.