Dr Tracy Li1,3, Dr Nancy Li1,3, Dr Megha Bhadbhade1,3, A/Prof Danielle Ní Chróinín2,3, Dr Renuka Shanmugalingam1,3,4, Prof Angela Makris1,3,4
1Department of Nephrology, Liverpool Hospital, Sydney, Australia, 2Department of Geriatric Medicine, Liverpool Hospital, Sydney, Australia, 3South Western Sydney Clinical School, University of New South Wales, Sydney, Australia, 4Western Sydney Clinical School, University of Western Sydney, Sydney, Australia
Biography:
Dr Tracy Li is a Nephrology Advanced Trainee in the Central Southwest Network and has been mostly based at Liverpool and Royal Prince Alfred Hospital. Her interests include general nephrology, hypertension and glomerulonephritis.
Aim:
To identify predictors of all-cause mortality and dialysis dependence at 90 days following renal replacement therapy (RRT) and assess the long-term renal and functional outcomes in patients ≥75 years old.
Background:
Dialysis-requiring acute kidney injury (AKI) in hospitalised elderly patients is associated with significant morbidity and mortality. Although ANZDATA reports RRT outcomes; predictors of all-cause mortality, dialysis dependence and long-term outcomes in patients not reaching the 3-month reporting threshold remain unclear.
Methods:
Retrospective cohort study of patients (≥75years) who underwent RRT for AKI between 1st January 2018 to 31st December 2022 in South Western Sydney Local Health District. Data was extracted from the hospital electronic medical records. Statistics performed using SPSS with significance set at p<0.05 with Bonferroni correction as required. Primary outcome was 90-day all-cause mortality. Secondary outcomes included RRT dependence, renal function, hospitalisation-free days, MACE outcomes, functional status and living situation at 90 days and 1 year.
Results:
Among 409 patients (37.9% female), median age 79 years (IQR 77–82) with Charlson Comorbidity Index 6 (IQR 6-8) and Clinical Frailty Scale of 4 (IQR 3-4), the three main dialysis indications included acidosis (48.4%), electrolyte abnormalities (22.7%) and fluid overload (20.3%). 90 days and 1-year post-RRT, mortality was 44.5% and 53.3%, dialysis dependence 16.6% and 14.7% respectively with 0.73% withdrawing from dialysis. Lower admission creatinine (aOR 0.89[95%CI0.82-0.95],p=0.001) and prior nephrology care (aOR 0.47[95%CI0.30-0.74],p<0.001) were associated with reduced 90-day mortality. Among survivors, 38% were readmitted within 90 days; 6.7% discharged to nursing homes and 50.2% required services, compared to 0% and 22% pre-admission.
Conclusions:
Among a selected population ≥75 years old commencing RRT for AKI, there is significant mortality and substantial post-survival functional decline
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