Creatinine increase in elderly means increased renal disease, mortality

The 10-year retrospective study, led by UAB nephrologist Britt Newsome, M.D, is the first systematic description of creatinine increase and longer-term end stage renal disease and mortality risk. Previous studies showed a relationship between reductions in kidney function during hospitalization and higher mortality rates.

“Previous studies have shown that a rise in serum creatinine level of 0.3 milligrams per deciliter or more during hospitalization is associated with higher in-hospital mortality, longer stays and higher costs,” Newsome said. “However, little was known about the long-term risks of subsequent end-stage renal disease and mortality in this population. The long-term risks we observed suggest that even the least severe category of kidney injury may indicate a worse prognosis.”

The study looked at 87,094 Medicare beneficiaries admitted to 4,473 hospitals across the country suffering from a heart attack, or acute myocardial infarction. They studied changes in creatinine levels of those patients from 0.1 to 3.0 milligrams per deciliter. The mean age of the patients was 77.1 years old.

Incidences of end stage renal disease and death were greatest among patients with larger changes in creatinine level, and all levels of serum creatinine increase were associated with a greater risk of end stage renal disease and death.

“We chose to examine a population of Medicare beneficiaries because the incidence of acute kidney injury has been increasing in this population for the past 10 years,” Newsome said. “Further, patients with cardiovascular disease are at a particularly high risk of chronic kidney disease as well as acute kidney injury. In future studies we will want to determine if this relationship exists in patients admitted to the hospital for other conditions.”

With these findings, the study calls for clinicians to closely monitor and aggressively treat patients experiencing increases in creatinine levels.

“The study also shows that giving patients beta blockers and aspirin can help treat these patients and possibly prevent death in the long term, regardless of creatinine change during hospitalization,” Newsome said.

Source: University of Alabama at Birmingham

Nephrologists debate uses of estimated kidney function
A routinely available laboratory result called the estimated glomerular filtration rate (eGFR) provides a simple indicator of kidney function and may increase early diagnoses of chronic kidney disease (CKD). However, widespread use of eGFR for this purpose may have inherent flaws and dangers—including a risk that large numbers of elderly patients will be misclassified as having CKD.
New method assesses risks for heart failure patients
Data from 260 hospitals across the United States has led to the creation of a new method for physicians to more accurately determine the severity of heart failure in patients upon hospital admission, with a goal of reducing in-hospital mortality and more quickly identifying triage methods and treatment decisions. The model is discussed in the July 29 issue of the Journal of the American College of Cardiology.
New kidney protein speeds/improves the diagnosis of failing kidneys
Walk into any emergency department complaining of chest pain and you are likely to have blood drawn. Within hours it should be clear whether you've had a heart attack, based on enzyme levels in your blood and whether those levels reveal the tissue damage normally associated with a heart attack or other major cardiac event.
Muscle mass may not fully explain higher creatinine in blacks with kidney disease
Why do black patients with advanced kidney disease have higher levels of creatinine, a standard indicator of kidney function, than whites" Contrary to what doctors have thought, the difference may not necessarily reflect differences in muscle mass related to younger age or differences in body composition, reports a study in the July 2008 issue of the Clinical Journal of the American Society of Nephrology (CJASN).
Ibuprofen restores learning ability in rats with liver failure
Cognitive impairment is one of the neurological effects in patients with hepatic encephalopathy (abnormal brain function due to severe liver disease). For the first time, a new study showed that treatment with an anti-inflammatory improves cognitive function in rats induced with chronic liver failure.
Kidney damage caused by iodinated contrast material thought to be overestimated, study shows
The use of iodinated contrast material may be less damaging to the kidneys than previously recorded, according to a recent study conducted by researchers at Columbia University Medical Center in New York, NY.
New research links drinking lowfat milk to lower risk for heart disease
Grabbing as little as one glass of lowfat or fat free milk could help protect your heart, according to a new study published in the American Journal of Clinical Nutrition. Researchers found that adults who had at least one serving of lowfat milk or milk products each day had 37 percent lower odds of poor kidney function linked to heart disease compared to those who drank little or no lowfat milk.
New lab test predicts risk of kidney injury after surgery
A simple laboratory test may provide a new way for doctors to identify patients at risk of developing potentially severe acute kidney injury (AKI) after surgery—up to three days before the problem would otherwise be detected, reports a pilot study in the May 2008 issue of the Clinical Journal of the American Society of Nephrology.

Creatinine increase in elderly means increased renal disease, mortality

Related stories:

News discussion: