Renal consultations in hospitalized very old people

Abstract

Renal consultations between January 1, 1987 and March 31, 1991 were reviewed to assess the etiology and outcome of renal disorders in patients ≥85 years old. Of 2491 consultations, 41 (2%) were in these very old patients. A sample of 23 charts (56%) at Kings County Hospital Center (KCHC) were compared with 20 ‘control’ charts selected randomly as equivalent in age and service, but not related to kidney disease. In addition, we reviewed all KCHC admissions to the medical and surgical services during the study period ( n = 50,991) to ascertain admission diagnoses and death rates sorted by age. There were 15 deaths in the renal consultation group (65%) but only 2 in 20 control very old patients (10%) ( p < 0.0007). Patients ≥85 years old, who had a renal consultation, died at a significantly higher rate than those in the same age range who did not have an identified renal problem. Kidney patients had significantly higher blood urea nitrogen and serum creatinine levels than did the controls. In these very old kidney patients, death was attributed to common medical problems including hypertension, diabetes, stroke, cardiac disease, and pneumonia. Only two patients died from acute renal failure. The two deaths in control patients were due to extensive burns and pneumonia-septicemia. An analysis of reasons for admission to KCHC, when sorted by age, showed a progressive rise in kidney disorders, from 7.5% of admissions in those aged 18 to 44 years to 28.6% in the very old group aged ≥85 years old. We have concluded that a request for a nephrologic consultation must be taken seriously in very old patients. From the current data, we cannot distinguish the exact contribution of intrinsic renal disease from prerenal azotemia as an agonal event in extrarenal disease. With respect to the subset of patients with azotemia due to renal disease, any reduction in the two-thirds mortality in the very old patients seen in renal consultation may be contingent — in part — on earlier introduction of dialytic therapy at lower levels of azotemia.