Chronic kidney disease (CKD) in hospitalised geriatric patients: prevalence, characteristics and impact on outcomes

Aims: The prevalence of CKD defined as a glomerular filtration rate (GFR) <60 mL/min/1.73 m2 is about 10% in the general population. We aimed to evaluate the prevalence and relationships between CKD, causes of admission, comorbidities and outcomes in hospitalised geriatric patients, issues which have not been explored in detail previously. Methods: Demographic, clinical and laboratory data were analysed in all 585 patients (mean age 85.7 6.9 years, 63.6% women) admitted to the Acute Care of the Elderly unit at The Canberra Hospital in 2014. Results: CKD was prevalent in 328 (56.1%) patients (62.2% women) and significantly associated with exacerbation of congestive heart failure (OR = 2.17, 95% CI 1.12 4.21, p = 0.022), infections (OR = 1.62, 95% CI 1.16 2.25, p = 0.004), developing acute kidney injury (OR 2.87, 95% CI 1.645.07, p < 0.001) and presence of anaemia (OR 1.55, 95% CI 1.102.18, p = 0.012). Multivariate logistic analysis identified history of coronary artery disease (OR = 2.08, 95% CI 1.233.53, p = 0.006), heart failure (OR = 2.89, 95% CI 1.704.93, p < 0.001) and hyperparathyroidism (serum PTH >6.8 pmol/L, OR = 2.12, 95% CI 1.333.38, p = 0.002) as independent significant correlates of CKD. CKD was found to be an independent predictor of in-hospital mortality (OR = 1.89, 95% CI 1.043.43, p = 0.037). Conclusion: The prevalence of CKD among hospitalised older people is very high (56.1%); it is associated with heart failure, coronary artery disease, anaemia, hyperparathyroidism, requires admissions for exacerbation of heart failure, developing infections and/or acute kidney injury and increases the risk of in-hospital mortality 2-fold. New practical multidimensional diagnostic, preventive and therapeutic approaches with aggressive strategies are needed to reduce the burden of CKD in older people.