Treatment-related acute renal failure in the elderly: a hospital-based prospective study

Background. Elderly individuals need a host of diagnostic procedures and th erapeutic interventions to take care of ailments. This prospective study wa s carried out to determine the magnitude of treatment-related acute renal f ailure (ARF) in the elderly in a hospital setting, to know about pathogenet ic factors and to study the factors that could predict an adverse outcome. Methods. All elderly patients (>60 years) admitted over a 12-month period w ere screened prospectively throughout their hospital stay for the developme nt of ARF. Results. Of 31 860 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%) ea ch, contrast medium in 10 (16.9%) and postoperative ARF occurred in 15 (25. 4%) patients. These pathogenetic factors were responsible for ARF in differ ent combinations. Amongst these combination of pathogenetic factors, radioc ontrast administration (partial chi(2) 28.1, P<0.0001), surgery (partial ch i(2) 14.89, P=0.001), and drugs (partial chi(2) 6.22, P=0.0126) predicted A RF on their own. Nine patients (15.23%) needed dialytic support. Of 59 pati ents, 15 (25.4%) died, of those who survived, 38 (86.3%) recovered renal fu nction 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%; chi( 2) 8.3, P=0.03). Sepsis (odds ratio 43), oliguria (odds ratio 64), and hypo tension (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%, wit h more than one pathogenetic factor playing a role in the development of AR F in the majority. Sepsis, hypotension, and oliguria were the independent p redictors of poor patient outcome.