Haemodynamic frailty - A risk factor for acute kidney injury in the elderly

被引:23
作者
Docherty, Neil G. [1 ,11 ]
Delles, Christian [2 ,11 ]
D'Haese, Patrick [3 ,11 ]
Layton, Anita T. [4 ,5 ,6 ,7 ,11 ]
Martinez-Salgado, Carlos [8 ,9 ,10 ,11 ]
Vervaet, Benjamin A. [3 ,11 ]
Lopez-Hernandez, Francisco J. [10 ,11 ]
机构
[1] Univ Coll Dublin, Sch Med, Conway Inst Biomol & Biomed Res, Diabet Complicat Res Ctr, Dublin, Ireland
[2] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland
[3] Univ Antwerp, Lab Pathophysiol, Antwerp, Belgium
[4] Univ Waterloo, Dept Appl Math, Waterloo, ON N2L 3G1, Canada
[5] Univ Waterloo, Dept Biol, Waterloo, ON N2L 3G1, Canada
[6] Univ Waterloo, Sch Comp Sci, Waterloo, ON N2L 3G1, Canada
[7] Univ Waterloo, Sch Pharmacol, Waterloo, ON N2L 3G1, Canada
[8] Inst Biomed Res Salamanca IBSAL, Salamanca, Spain
[9] Univ Salamanca USAL, Dept Physiol & Pharmacol, Salamanca, Spain
[10] Inst Salud Carlos III, Natl Network Kidney Res REDINREN, RD016 0009 0025, Madrid, Spain
[11] Dis & Theranost Modelling DisMOD Working Grp, Salamanca, Spain
基金
加拿大自然科学与工程研究理事会;
关键词
Elderly; Haemodynamic frailty; Dehydration; Acute kidney injury; RENAL FUNCTIONAL RESERVE; BLOOD-FLOW; WATER-DEPRIVATION; HEART-FAILURE; NURSING-HOMES; NEPHROTOXICITY; DEHYDRATION; AGE; GENTAMICIN; INHIBITORS;
D O I
10.1016/j.arr.2021.101408
中图分类号
Q2 [细胞生物学];
学科分类号
071009 ; 090102 ;
摘要
Clinical frailty in the elderly is defined by a composite measure of functional psychomotor decline. Herein, we develop the concept of haemodynamic frailty (HDF), a state of increased predisposition to disease prevalent in the elderly and characterised by impairment of the network of compensatory responses governing the defence of circulatory volume and adaptive haemodynamic function. We review the factors predisposing the elderly to HDF, with a focus on the impaired capacity to sustain total body water balance. As a component of HDF, dehydration generates vulnerability to diseases caused by tissue hypoperfusion, including acute kidney injury. We provide a detailed mechanistic explanation of how dehydration and depletion of the intravascular volume impacts on renal blood flow to become an important element of the heightened risk of acute kidney injury (AKI) in the elderly. We bring these mechanistic considerations into the clinical context with reference to examples of how pre-renal (haemodynamic) and intrinsic (involving renal parenchymal damage) AKI risk is elevated in the setting of dehydration. Finally, we present HDF as a state of opportunity to prevent disease, for which diagnostic and interventional standards need to be refined. Further prospective studies are warranted to help clarify the clinical utility of assessing and managing HDF with regard to the mitigation of AKI risk in the elderly.
引用
收藏
页数:11
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