Kidney Week

Abstract: TH-PO082

Association of Age, Frailty, and Strategy for Initiation of Kidney Replacement Therapy: A Post Hoc Analysis of the STARRT-AKI Trial

Session Information

• AKI: Clinical, Outcomes, and Trials - Epidemiology and Pathophysiology
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Wang, Amanda Y, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia

Amanda Y Wang, MD, MS, MSc, PhD

• Serpa Neto, Ary, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia

Ary Serpa Neto, MD, MSc, PhD

• Gallagher, Martin P., The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia

Martin P. Gallagher, MBBS, PhD, MPH

• Wald, Ron, Division of Nephrology, St. Michael's Hospital, University of Toronto, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada

Ron Wald, MDCM, MPH

• Bagshaw, Sean M., Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada

Sean M. Bagshaw, MD

• Bellomo, Rinaldo, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia

Rinaldo Bellomo, MD, MBBS

Group or Team Name

• The STARRT-AKI Investigators.

Background

Acute kidney injury (AKI) is a significant public health issue, and its incidence continues to rise. Older age is associated with a high risk of AKI and mortality, which often poses a clinical dilemma particularly with the implementation of invasive management such as renal-replacement therapy (RRT). The aim of this study is to assess the association of age and frailty with clinical outcomes in patients with severe AKI, according to accelerated and standard 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 2927 patients randomized in the STARRT-AKI trial, 1616 (55.2%) were aged ≥ 65 years (median [IQR] 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-OR, 1.81 [1.53 to 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 to 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 to 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.