Acute Kidney Injury in Older Adults

Older patients are predisposed to develop acute kidney injury (AKI) due to kidney molecular, cellular, structural, and functional changes associated with normal aging itself, and also the co-morbidities that often develop as a person ages. Etiologies of AKI include prerenal, intrarenal, and postrenal causes, with the predominance of acute tubular necrosis (ATN) and obstruction often concurring with iatrogenic components which lead to multiple insults on frail kidneys. The insidious onset of AKI in older adults may be associated with delayed diagnosis, a higher number of complications, and poor outcomes. Once established, AKI is associated with a higher risk for chronic kidney disease (CKD), kidney failure, and mortality. Among the proposed preventive strategies, the main ones are oriented toward preserving kidney perfusion and preventing nephrotoxic insults through a meticulous review of medications and their dose. Due to the intrinsic frailty, treatment of older adults with AKI should be individualized and include appropriate shared decision-making.