Acute renal failure in the elderly 1975-1990

Area of Science:

• Nephrology
• Critical Care Medicine
• Geriatrics

Background:

• Acute renal failure (ARF) in the elderly presents unique challenges.
• Understanding risk factors and outcomes in this population is crucial for effective treatment.

Purpose of the Study:

• To retrospectively analyze the outcomes of elderly patients (> 65 years) with ARF.
• To identify factors influencing mortality and assess survival trends over time.

Main Methods:

• Retrospective analysis of 242 elderly patients with ARF treated in a medical intensive care unit (1975-1990).
• Evaluation of underlying diseases, disease severity (ventilator use, septicemia, APACHE II), ARF causes, risk factors, complications, and outcomes.
• Comparison of mortality rates across different age groups and within the elderly cohort over time.

Main Results:

• Overall mortality for elderly patients with ARF was 61%, with 49% dying while ARF was still present.
• Mortality rates were comparable to younger age groups and did not increase with advanced age within the elderly cohort.
• Factors negatively impacting outcome included need for renal replacement therapy, high creatinine/BUN levels, anuria, ventilator dependency, and septicemia.
• A significant decrease in mortality from >70% to <50% was observed between 1975 and 1990 (p < 0.02), despite an increase in disease severity.

Conclusions:

• Age is not a significant determinant of survival in patients with ARF.
• Prognosis for ARF in the elderly has improved substantially over the past 15 years, even with increasing disease severity.
• Therapy should not be withheld from elderly patients experiencing ARF based on age alone.