Nephrol Dial Transplant (2000) 15: 212-217
© 2000 European Renal Association-European Dialysis and Transplant Association
Treatment-related acute renal failure in the elderly: a hospital-based prospective study
1 Departments of Nephrology and 2 Biostatistics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Correspondence and offprint requests to: Professor V. Sakhuja, Department of Nephrology, Post Graduate Institute of Medical Education and Reseach, Chandigarh 160 012, India.
Background. Elderly individuals need a host of diagnostic procedures and therapeutic interventions to take care of ailments. This prospective study was carried out to determine the magnitude of treatment-related acute renal failure (ARF) in the elderly in a hospital setting, to know about pathogenetic factors and to study the factors that could predict an adverse outcome.
Methods. All elderly patients (>60 years) admitted over a 12-month period were screened prospectively throughout their hospital stay for the development of ARF.
Results. Of 31860 patients admitted, 4176 (13%) were elderly. Of these 59 (1.4%) developed ARF in the hospital. Nephrotoxic drugs contributed towards development of ARF in 39 (66%), sepsis and hypoperfusion in 27 (45.7%) each, contrast medium in 10 (16.9%) and postoperative ARF occurred in 15 (25.4%) patients. These pathogenetic factors were responsible for ARF in different combinations. Amongst these combination of pathogenetic factors, radiocontrast administration (partial 
2 28.1, P<0.0001), surgery (partial 2 14.89, P=0.001), and drugs (partial 2 6.22, P=0.0126) predicted ARF on their own. Nine patients (15.23%) needed dialytic support. Of 59 patients, 15 (25.4%) died, of those who survived, 38 (86.3%) recovered renal function completely and six (13.6%) partially. Mortality in the elderly with ARF was significantly higher than in those without ARF (25.4 vs 12.5%; 2 8.3, P=0.03). Sepsis (odds ratio 43), oliguria (odds ratio 64), and hypotension (odds ratio 15) were independent predictors of poor patient outcome on logistic regression analysis.
Conclusion. Incidence of treatment-related ARF in the elderly was 1.4%, with more than one pathogenetic factor playing a role in the development of ARF in the majority. Sepsis, hypotension, and oliguria were the independent predictors of poor patient outcome.
Keywords: geriatric; hospital acquired; nephrotoxic drugs; radiocontrast; sepsis
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