Acute kidney injury and rehabilitation outcomes among elderly patients with chronic kidney disease

Introduction: As the geriatric population rapidly grows, so does the incidence of chronic kidney disease (CKD). CKD patients have higher incidence of fractures, stroke and hospitalizations requiring rehabilitation along with the need for suitable rehabilitation programs to decrease disability and improve functionality to maintain independence in activities of daily life of elderly CKD patients. Considering that survivors of acute kidney injury (AKI) tend to experience decreased quality of life with aggravating frailty, rehabilitation in the elderly with kidney injury becomes even more complex. The aim of this study was to Examine the impact of AKI on the outcomes of rehabilitation among elderly patients with CKD.Methods: For this retrospective, observational study, the electronic medical records of all patients who were hospitalized in the Rehabilitation Department were reviewed. We assessed functional status at the beginning and at the end of rehabilitation, renal outcome and all-cause mortality among elderly patients with CKD who had AKI and compared to those who did not have AKI.Results: The study cohort included 183 elderly patients with non-dialysis dependent CKD. Patients with AKI had a higher prevalence of heart failure and lower baseline estimated GFR, as compared with patients who did not have AKI. They were admitted to rehabilitation at worse functional capacity and were also discharged with lower FIM scores. Overall OR for all-cause death among AKI versus non-AKI patients was 3.2 (95%CI: 1.6-6.5; p=0.001).Conclusion: AKI and CKD are interconnected syndromes that associate with worse rehabilitation outcomes and mortality among elderly patients.