Association of Age, Frailty, and Strategy for Initiation of Renal-Replacement Therapy: A Post Hoc analysis of the STARRT-Acute Kidney Injury Trial.

IF 2.2 3区医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-01-01 Epub Date: 2024-07-24 DOI:10.1159/000540323

Amanda Ying Wang, Ary Serpa Neto, Martin Gallagher, Ron Wald, Sean M Bagshaw, Rinaldo Bellomo

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Abstract

Introduction: This study was designed to assess the association of age and frailty with clinical outcomes in patients with severe acute kidney injury (AKI), according to accelerated and standard renal-replacement therapy (RRT) initiation strategies in the STARRT-AKI trial.

Methods: This was a secondary analysis of an international randomized trial. Older age was defined as ≥65 years. Frailty was assessed using the clinical frailty scale (CFS) score and defined as a 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 2,927 patients randomized in the STARRT-AKI trial, 1,616 (55.2%) were aged ≥65 years (median [interquartile range] 73.9 [69.4-78.9]). Older patients had greater comorbid cardiovascular and chronic kidney disease, were more likely to be surgical admissions and to receive vasopressors at baseline. Older patients had higher 90-day mortality (50.4% vs. 35.6%, adjusted-odds ratio (OR), 1.81 [1.53-2.13], 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 [0.82-1.79], 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, RRT dependence at 90 days, and other secondary outcomes. There was no significant difference in the proportion of patients who received RRT in the standard-strategy stratified by age groups (adjusted-OR, 0.85 [0.67-1.08], p = 0.180).

Conclusion: 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.

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年龄、虚弱程度与肾脏替代疗法起始策略的关系：STARRT-AKI 试验的事后分析。

目的：根据 STARRT-AKI 试验中的加速和标准肾脏替代治疗（RRT）启动策略，评估严重 AKI 患者的年龄和虚弱程度与临床预后的关系：这是一项国际随机试验的二次分析。高龄定义为≥65岁。体弱采用临床体弱量表（CFS）评分进行评估，定义为评分≥5分。主要结果是 90 天内的全因死亡率。次要结果包括 RRT 依赖性和 90 天无 RRT 天数。我们使用逻辑回归、线性回归和交互检验来探讨年龄和虚弱对临床结果的影响：在 STARRT-AKI 试验的 2927 名随机患者中，有 1616 人（55.2%）年龄≥ 65 岁（中位数 [IQR] 73.9 [69.4 - 78.9]）。老年患者合并心血管疾病和慢性肾脏疾病的比例更高，更有可能接受手术治疗，基线时也更有可能接受血管加压治疗。老年患者的 90 天死亡率较高（50.4% 对 35.6%，调整后的 OR 值为 1.81 [1.53 至 2.13]，p<0.001）。年龄较大和较年轻的患者在90天时对RRT的依赖性没有明显差异（8.7% vs. 7.8%，调整后的OR，1.21 [0.82 to 1.79]，p=0.325）。体弱患者的死亡率较高；但在 90 天的 RRT 依赖性方面没有差异。年龄和CFS评分与死亡率、90天时的RRT依赖性以及其他次要结果之间没有明显的交互作用。在标准策略中，不同年龄组接受 RRT 治疗的患者比例无明显差异（调整后的 OR 值为 0.85 [0.67 至 1.08]，P=0.180）：在 STARRT-AKI 试验的二次分析中，年龄较大和体弱的患者在 90 天时的死亡率较高；但在 RRT 依赖性方面没有差异。老年或体弱患者的死亡率和 RRT 依赖性并未因 RRT 启动策略而改变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.