Background:The kidneys play a central role in serum potassium(K+)homeostasis,and their dysfunction leads to electrolyte disorders.We aimed to examine the relationship between different levels of K+and mortality among ...Background:The kidneys play a central role in serum potassium(K+)homeostasis,and their dysfunction leads to electrolyte disorders.We aimed to examine the relationship between different levels of K+and mortality among very elderly patients with acute kidney injury(AKI).Methods:We retrospectively enrolled very elderly patients(≥75 years)with AKI from the hospital information system of the Chinese PLA General Hospital from January 1,2007 to December 31,2018.All-cause mortality was examined according to six predefined K+levels:<3.50 mmol/L,3.50-3.79 mmol/L,3.80-4.09 mmol/L,4.10-4.79 mmol/L,4.80-5.49 mmol/L,and≥5.50 mmol/L.We estimated the risk of all-cause mortality using the multivariable adjusted Cox proportional hazard model with the normal K+level at 3.50-3.79 mmol/L as a reference.Results:In total,747 patients were deemed suitable for the final evaluation.The median age of the 747 par-ticipants was 88(84-91)years.After 90 days,the mortality rates in the six strata were 28.3%,21.9%,30.1%,35.4%,45.2%,and 58.3%,respectively.In the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(hazard ratio[HR]:1.638;95%confidence interval[CI]:1.016-2.642),4.80-5.49 mmol/L(HR:2.585;95%CI:1.524-4.384),and≥5.50 mmol/L(HR:2.587;95%CI:1.495-4.479)had an increased risk of all-cause mortality.After 1 year,the mortality rates in the six strata were 44.8%,41.1%,45.1%,51.8%,63.1%,and 76.3%,respectively.In the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(HR:1.452;95%CI:1.014-2.079),4.80-5.49 mmol/L(HR:2.151;95%CI:1.427-3.241),and≥5.50 mmol/L(HR:2.341;95%CI:1.514-3.620)had an increased risk of all-cause mortality.Conclusion:Increased serum K+levels,including levels of 4.10-5.49 mmol/L and≥5.50 mmol/L,were associated with a significantly increased short-and long-term risk of death.Serum K+has the potential to be a marker of disease severity among very elderly patients with AKI.展开更多
Background:This study evaluated the prognostic impact of acute kidney injury(AKI)duration on 90-d mortality and new-onset chronic kidney disease(CKD)progression in elderly patients.Methods:We retrospectively enrolled ...Background:This study evaluated the prognostic impact of acute kidney injury(AKI)duration on 90-d mortality and new-onset chronic kidney disease(CKD)progression in elderly patients.Methods:We retrospectively enrolled elderly patients(≥75 years;n=693)from the Chinese PLA General Hospital between January 1,2007 and December 31,2018.The 2012 Kidney Disease Improving Global Outcomes(KDIGO)defined serum creatinine(Scr)criteria were used to identify and classify AKI.Patients were divided into transient AKI(T-AKI)and persistent AKI(P-AKI)groups based on whether Scr levels returned to baseline within 48 h post-AKI.We further classified P-AKI based on AKI duration:(1)short duration:resolving AKI lasting 3–4 days;(2)medium duration:resolving AKI lasting 5–7 days;and(3)long duration:AKI lasting>7 days.Results:Among patients,62(9.0%)had T-AKI(1–2 days),104(15.0%)had short-duration,140(20.2%)had medium-duration,and 387(55.8%)had long-duration.In total,209(30.2%)died within 90 days;122(25.2%)developed CKD.After adjusting for multiple covariates,duration of AKI(3–4 days:hazard ratio[HR]=2.512;P=0.045;5–7 days:HR=3.154;P=0.015;>7 days:HR=6.212;P<0.001)was significantly associated with a higher 90-day mortality.Longer AKI duration(3–4 days:odds ratio[OR]=0.982;P=0.980;5–7 days:OR=1.322;P=0.661;>7 days:OR=7.007;P<0.001)was significantly associated with new-onset CKD of survivors.Conclusion:AKI duration is useful for predicting poorer clinical outcomes in elderly patients,emphasizing the importance of identifying an appropriate treatment window for early intervention.展开更多
基金the Special Scien-tific Research Project of Military Health Care(grant 20BJZ27 to FHZ),and the Military Medical。
文摘Background:The kidneys play a central role in serum potassium(K+)homeostasis,and their dysfunction leads to electrolyte disorders.We aimed to examine the relationship between different levels of K+and mortality among very elderly patients with acute kidney injury(AKI).Methods:We retrospectively enrolled very elderly patients(≥75 years)with AKI from the hospital information system of the Chinese PLA General Hospital from January 1,2007 to December 31,2018.All-cause mortality was examined according to six predefined K+levels:<3.50 mmol/L,3.50-3.79 mmol/L,3.80-4.09 mmol/L,4.10-4.79 mmol/L,4.80-5.49 mmol/L,and≥5.50 mmol/L.We estimated the risk of all-cause mortality using the multivariable adjusted Cox proportional hazard model with the normal K+level at 3.50-3.79 mmol/L as a reference.Results:In total,747 patients were deemed suitable for the final evaluation.The median age of the 747 par-ticipants was 88(84-91)years.After 90 days,the mortality rates in the six strata were 28.3%,21.9%,30.1%,35.4%,45.2%,and 58.3%,respectively.In the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(hazard ratio[HR]:1.638;95%confidence interval[CI]:1.016-2.642),4.80-5.49 mmol/L(HR:2.585;95%CI:1.524-4.384),and≥5.50 mmol/L(HR:2.587;95%CI:1.495-4.479)had an increased risk of all-cause mortality.After 1 year,the mortality rates in the six strata were 44.8%,41.1%,45.1%,51.8%,63.1%,and 76.3%,respectively.In the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(HR:1.452;95%CI:1.014-2.079),4.80-5.49 mmol/L(HR:2.151;95%CI:1.427-3.241),and≥5.50 mmol/L(HR:2.341;95%CI:1.514-3.620)had an increased risk of all-cause mortality.Conclusion:Increased serum K+levels,including levels of 4.10-5.49 mmol/L and≥5.50 mmol/L,were associated with a significantly increased short-and long-term risk of death.Serum K+has the potential to be a marker of disease severity among very elderly patients with AKI.
基金funded by grants from the Special Scientific Research Project of Military Health Care(grant 20BJZ27 to FHZ)the Military Medical Innovation Project(grants 18CXZ026 and CX19010 to FHZ).
文摘Background:This study evaluated the prognostic impact of acute kidney injury(AKI)duration on 90-d mortality and new-onset chronic kidney disease(CKD)progression in elderly patients.Methods:We retrospectively enrolled elderly patients(≥75 years;n=693)from the Chinese PLA General Hospital between January 1,2007 and December 31,2018.The 2012 Kidney Disease Improving Global Outcomes(KDIGO)defined serum creatinine(Scr)criteria were used to identify and classify AKI.Patients were divided into transient AKI(T-AKI)and persistent AKI(P-AKI)groups based on whether Scr levels returned to baseline within 48 h post-AKI.We further classified P-AKI based on AKI duration:(1)short duration:resolving AKI lasting 3–4 days;(2)medium duration:resolving AKI lasting 5–7 days;and(3)long duration:AKI lasting>7 days.Results:Among patients,62(9.0%)had T-AKI(1–2 days),104(15.0%)had short-duration,140(20.2%)had medium-duration,and 387(55.8%)had long-duration.In total,209(30.2%)died within 90 days;122(25.2%)developed CKD.After adjusting for multiple covariates,duration of AKI(3–4 days:hazard ratio[HR]=2.512;P=0.045;5–7 days:HR=3.154;P=0.015;>7 days:HR=6.212;P<0.001)was significantly associated with a higher 90-day mortality.Longer AKI duration(3–4 days:odds ratio[OR]=0.982;P=0.980;5–7 days:OR=1.322;P=0.661;>7 days:OR=7.007;P<0.001)was significantly associated with new-onset CKD of survivors.Conclusion:AKI duration is useful for predicting poorer clinical outcomes in elderly patients,emphasizing the importance of identifying an appropriate treatment window for early intervention.
