Danira Medunjanin , Bethany J. Wolf , Roberto Pisoni , David J. Taber , John L. Pearce , Kelly J. Hunt
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This study examined the association between AKI and incident kidney failure with replacement therapy (KFRT) while evaluating age as an effect modifier of this relationship.</p></div><div><h3>Study Design</h3><p>Retrospective cohort study.</p></div><div><h3>Setting & Participants</h3><p>24,133 Veterans at least 65 years old with incident CKD stage 4 from 2011 to 2013.</p></div><div><h3>Exposures</h3><p>AKI, AKI severity, and age.</p></div><div><h3>Outcomes</h3><p>KFRT and death.</p></div><div><h3>Analytical Approach</h3><p>The Fine-Gray competing risk regression was used to model AKI and incident KFRT with death as a competing risk. A Cox regression was used to model AKI severity and death.</p></div><div><h3>Results</h3><p>Despite a nonsignificant age interaction between AKI and KFRT, a clinically relevant combined effect of AKI and age on incident KFRT was observed. Compared with our oldest age group without AKI, those aged 65-74 years with AKI had the highest risk of KFRT (subdistribution HR [sHR], 14.9; 95% CI, 12.7-17.4), whereas those at least 85 years old with AKI had the lowest (sHR, 1.71; 95% CI, 1.22-2.39). Once Veterans underwent KFRT, their risk of death increased by 44%. A 2-fold increased risk of KFRT was observed across all AKI severity stages. However, the risk of death increased with worsening AKI severity.</p></div><div><h3>Limitations</h3><p>Our study lacked generalizability, was restricted to ever use of medications, and used inpatient serum creatinine laboratory results to define AKI and AKI severity.</p></div><div><h3>Conclusions</h3><p>In this national cohort, advanced age was protective against incident KFRT but not death. This is likely explained by the high frequency of deaths observed in this population (51.1%). Nonetheless, AKI and younger age are substantial risk factors for incident KFRT.</p></div><div><h3>Plain Language Summary</h3><p>Older adults are at risk of acute kidney injury (AKI) and subsequent nonrecovery from AKI, resulting in long-term dialysis. Hospitalized patients have often been used in the past to study AKI. This could lead to biased conclusions when inferring from sicker populations. That is why we created a national cohort of 24,133 Veterans at least 65 years old with incident chronic kidney disease (CKD) stage 4 to examine the relationship between AKI and age and subsequent kidney failure with replacement therapy (KFRT). The data have showed that AKI and younger age are substantial risk factors for incident KFRT. As for older age, it appears to be protective against KFRT but not death. This is likely explained by the high frequency of deaths observed in our cohort.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000360/pdfft?md5=053368f03f34f71c9c2f30ed6622d81a&pid=1-s2.0-S2590059524000360-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Acute Kidney Injury and Subsequent Kidney Failure With Replacement Therapy Incidence in Older Adults With Advanced CKD: A Cohort Study of US Veterans\",\"authors\":\"Danira Medunjanin , Bethany J. Wolf , Roberto Pisoni , David J. Taber , John L. Pearce , Kelly J. 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This study examined the association between AKI and incident kidney failure with replacement therapy (KFRT) while evaluating age as an effect modifier of this relationship.</p></div><div><h3>Study Design</h3><p>Retrospective cohort study.</p></div><div><h3>Setting & Participants</h3><p>24,133 Veterans at least 65 years old with incident CKD stage 4 from 2011 to 2013.</p></div><div><h3>Exposures</h3><p>AKI, AKI severity, and age.</p></div><div><h3>Outcomes</h3><p>KFRT and death.</p></div><div><h3>Analytical Approach</h3><p>The Fine-Gray competing risk regression was used to model AKI and incident KFRT with death as a competing risk. A Cox regression was used to model AKI severity and death.</p></div><div><h3>Results</h3><p>Despite a nonsignificant age interaction between AKI and KFRT, a clinically relevant combined effect of AKI and age on incident KFRT was observed. Compared with our oldest age group without AKI, those aged 65-74 years with AKI had the highest risk of KFRT (subdistribution HR [sHR], 14.9; 95% CI, 12.7-17.4), whereas those at least 85 years old with AKI had the lowest (sHR, 1.71; 95% CI, 1.22-2.39). Once Veterans underwent KFRT, their risk of death increased by 44%. A 2-fold increased risk of KFRT was observed across all AKI severity stages. However, the risk of death increased with worsening AKI severity.</p></div><div><h3>Limitations</h3><p>Our study lacked generalizability, was restricted to ever use of medications, and used inpatient serum creatinine laboratory results to define AKI and AKI severity.</p></div><div><h3>Conclusions</h3><p>In this national cohort, advanced age was protective against incident KFRT but not death. This is likely explained by the high frequency of deaths observed in this population (51.1%). 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引用次数: 0
摘要
理由与ampamp; 目标高龄是慢性肾脏病(CKD)发展的主要风险因素,而慢性肾脏病的发展具有高度异质性。急性肾损伤(AKI)住院率正在上升,尤其是在老年人中。以往的急性肾损伤流行病学分析主要针对住院人群,这可能会使分析结果偏向于病情较重的人群。本研究探讨了AKI与肾衰竭替代疗法(KFRT)之间的关系,同时评估了年龄对这一关系的调节作用。研究设计回顾性队列研究.研究地点及范围; 参与者24,133名退伍军人,年龄至少65岁,2011年至2013年期间发生CKD四期.暴露AKI、AKI严重程度和年龄.结果KFRT和死亡.分析方法Fine-Gray竞争风险回归用于模拟AKI和KFRT事件,死亡为竞争风险。结果尽管AKI和KFRT之间的年龄交互作用不显著,但观察到AKI和年龄对KFRT事件有临床相关的联合影响。与无 AKI 的最大年龄组相比,65-74 岁的 AKI 患者发生 KFRT 的风险最高(亚分布 HR [sHR],14.9;95% CI,12.7-17.4),而至少 85 岁的 AKI 患者发生 KFRT 的风险最低(sHR,1.71;95% CI,1.22-2.39)。一旦退伍军人接受了 KFRT,他们的死亡风险就会增加 44%。在所有 AKI 严重程度分期中,KFRT 的风险都增加了 2 倍。局限性我们的研究缺乏普遍性,仅限于曾经使用过的药物,并使用住院患者的血清肌酐化验结果来定义 AKI 和 AKI 严重程度。这可能是因为在该人群中观察到的死亡频率较高(51.1%)。白话摘要老年人面临急性肾损伤(AKI)的风险,随后可能无法从 AKI 中恢复,导致长期透析。过去常常使用住院患者来研究 AKI。这可能会导致从病情较重的人群中推断出有偏差的结论。因此,我们建立了一个由 24,133 名至少 65 岁、患有慢性肾脏病 (CKD) 4 期的退伍军人组成的全国队列,以研究 AKI 与年龄和随后的肾衰替代治疗 (KFRT) 之间的关系。数据显示,AKI 和较年轻的年龄是发生 KFRT 的主要风险因素。至于年龄较大,似乎对 KFRT 有保护作用,但对死亡没有保护作用。这可能是由于在我们的队列中观察到的高死亡频率造成的。
Acute Kidney Injury and Subsequent Kidney Failure With Replacement Therapy Incidence in Older Adults With Advanced CKD: A Cohort Study of US Veterans
Rationale & Objective
Advanced age is a major risk factor for chronic kidney disease (CKD) development, which has high heterogeneity in disease progression. Acute kidney injury (AKI) hospitalization rates are increasing, especially among older adults. Previous AKI epidemiologic analyses have focused on hospitalized populations, which may bias results toward sicker populations. This study examined the association between AKI and incident kidney failure with replacement therapy (KFRT) while evaluating age as an effect modifier of this relationship.
Study Design
Retrospective cohort study.
Setting & Participants
24,133 Veterans at least 65 years old with incident CKD stage 4 from 2011 to 2013.
Exposures
AKI, AKI severity, and age.
Outcomes
KFRT and death.
Analytical Approach
The Fine-Gray competing risk regression was used to model AKI and incident KFRT with death as a competing risk. A Cox regression was used to model AKI severity and death.
Results
Despite a nonsignificant age interaction between AKI and KFRT, a clinically relevant combined effect of AKI and age on incident KFRT was observed. Compared with our oldest age group without AKI, those aged 65-74 years with AKI had the highest risk of KFRT (subdistribution HR [sHR], 14.9; 95% CI, 12.7-17.4), whereas those at least 85 years old with AKI had the lowest (sHR, 1.71; 95% CI, 1.22-2.39). Once Veterans underwent KFRT, their risk of death increased by 44%. A 2-fold increased risk of KFRT was observed across all AKI severity stages. However, the risk of death increased with worsening AKI severity.
Limitations
Our study lacked generalizability, was restricted to ever use of medications, and used inpatient serum creatinine laboratory results to define AKI and AKI severity.
Conclusions
In this national cohort, advanced age was protective against incident KFRT but not death. This is likely explained by the high frequency of deaths observed in this population (51.1%). Nonetheless, AKI and younger age are substantial risk factors for incident KFRT.
Plain Language Summary
Older adults are at risk of acute kidney injury (AKI) and subsequent nonrecovery from AKI, resulting in long-term dialysis. Hospitalized patients have often been used in the past to study AKI. This could lead to biased conclusions when inferring from sicker populations. That is why we created a national cohort of 24,133 Veterans at least 65 years old with incident chronic kidney disease (CKD) stage 4 to examine the relationship between AKI and age and subsequent kidney failure with replacement therapy (KFRT). The data have showed that AKI and younger age are substantial risk factors for incident KFRT. As for older age, it appears to be protective against KFRT but not death. This is likely explained by the high frequency of deaths observed in our cohort.