ASSOCIATION OF AGE, FRAILTY AND STRATEGY FOR INITIATION OF RENAL REPLACEMENT THERAPY: A POST-HOC ANALYSIS OF THE STARRT-AKI TRIAL.
A/Prof. Amanda Ying Wang1, Dr Ary Serpa Neto4, Prof Martin Gallagher1, Prof Ron Wald5, Prof Sean Bagshaw6, Prof Rinaldo Bellomo7
1The George Institute For Global Health, University of New South Wales, Australia, 2The Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, Australia, 3Concord Clinical School, Faculty of Medicine, University of Sydney, Concord, Australia, 4Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, , Australia, 5Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Canada, 6Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Canada, 7Department of Intensive Care, Austin Hospital, Melbourne, Australia, Australia
Aim: To assess the association of age and frailty with clinical outcomes in patients with severe AKI, according to accelerated and standard renal-replacement therapy (RRT) initiation strategies in the STARRT-AKI trial.
Background: Older age is associated with a high risk of AKI and mortality, which often poses a clinical dilemma particularly with the implementation of invasive management such as RRT.
Methods: This was a secondary analysis of STARRT-AKI. Older age was defined as ≥65 years. Frailty was defined as a clinical frailty scale (CFS) score ≥5. The primary outcome was all-cause mortality at 90 days. Secondary outcomes included RRT dependence and RRT-free days at 90 days. We used logistic and linear regression and interaction testing to explore the impact of age and frailty on clinical outcomes.
Results: Of 2927 patients randomized in the STARRT-AKI trial, 1616 (55.2%) were aged ≥ 65 years (median [IQR] 73.9 [69.4 – 78.9]). Older patients had greater comorbid cardiovascular and chronic kidney disease. Older patients had higher 90-day mortality (50.4% vs. 35.6%, adjusted-OR, 1.81 [1.53 to 2.13], p<0.001). There was no significant difference in RRT dependence at 90 days between older and younger patients (8.7% vs. 7.8%, adjusted-OR, 1.21 [0.82 to 1.79], p=0.325). Patients with frailty had higher mortality; but no difference in RRT dependence at 90-days. There was no significant interaction between age and CFS score in relation to mortality and RRT dependence at 90 days.
Conclusions: In this secondary analysis of the STARRT-AKI trial, older and frail patients had higher mortality at 90 days; however, there was no difference in RRT dependence. Mortality and RRT dependence were not modified by RRT initiation strategy in older or frail patients.
Biography:
Associate Professor Amanda Ying Wang is a staff specialist nephrologist at Concord Hospital, Clinical Associate Professor at Macquarie University, Senior Research Fellow at George Institute, and Visiting Professor at Capital Medical University. After completion of her PhD in dialysis epidemiology at the University of Sydney, she was awarded the John Chalmers’ Servier post-doctoral fellowship followed by National Heart Foundation Post-doctoral fellowship, Jacquot Research Establishment Fellowship and NHF Vanguard Grant to support her research on Acute Kidney Injury and dialysis therapy. Amanda led the IMPROVE-AKI, DISCOVER, and PERFORM-AKI studies. She is an academic editor for PLOS One and Medicine Advances.