Age modifies the risk factor profiles for acute kidney injury among recently diagnosed type 2 diabetic patients: a population-based study

Abstract

The incidence of acute kidney injury (AKI) rises with age and is associated with multiple risk factors. Here, we compared the risk factors for AKI between younger and older incident diabetic patients to examine the trends in risk alteration for individual factors across different age groups. Between 2007 and 2013, we selected all incident type 2 diabetic adults from the Taiwan National Health Insurance registry, stratified based on age: young (< 65 years), old (≥ 65 but < 75 years), and older-old (≥ 75 years). All factors with potential renal influence (e.g., comorbidities, medications, and diagnostics/procedures) were recorded during the study period, with a nested case-controlled approach utilized to identify independent risk factors for AKI in each age group. Totally, 930,709 type 2 diabetic patients were categorized as young (68.7%), old (17.7%), or older-old (13.6%). Older-old patients showed a significantly higher incidence of AKI than the old and the young groups. Cardiovascular morbidities (hypertension, atrial fibrillation, acute coronary syndrome, and cerebrovascular disease) were shown to increase the risk of AKI, although the risk declined with increasing age. Chronic obstructive pulmonary disease and receiving cardiac catheterization elevated the risk of AKI preferentially in the older-old/old and older-old group, respectively, while the administration of angiotensin-converting enzyme/α-blocker and angiotensin receptor blocker/calcium channel blocker reduced the risk of AKI preferentially in the older-old and older-old/old group, respectively. In conclusion, our findings highlight the importance of devising age-specific risk factor panels for AKI in patients with recently diagnosed type 2 diabetes.

Keywords: Acute kidney injury; Diabetes mellitus; Geriatrics; Risk factors.

Fig. 1

Study algorithm for identifying diabetic patients with and without acute kidney injury (AKI) in different age groups. Incidence density matching of these groups were based on age, sex, and the date of DM diagnosis. DM, diabetes mellitus; NHI, National Health Insurance; T1DM, type 1 diabetes mellitus

Fig. 2

A diagram illustrating discrepancies in risk factors for acute kidney injury (AKI) between incident diabetic patients of different age groups. The solid black box represents a significant increase in the risk for AKI, while the dashed black box represents a significant reduction in risk. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; COPD, chronic obstructive pulmonary disease; CT, computed tomography; PVD, peripheral vascular disease

Fig. 3

The trend of risk estimates for acute kidney injury from individual factors listed in Tables 2, 3, and 4, among incident diabetic patients with different age groups. Convergence of risk toward neutrality was noted for all the risk factors among older participants. ACS, acute coronary syndrome; AKI, acute kidney injury; CeVD, cerebrovascular disease; CKD, chronic kidney disease

Fig. 4

The trend of risk estimates for acute kidney injury from individual factors listed in Tables 2, 3, and 4, among prevalent diabetic patients with different age groups. Convergence of risk toward neutrality was noted for all the risk factors among older participants. ACS, acute coronary syndrome; AKI, acute kidney injury; CeVD, cerebrovascular disease; CKD, chronic kidney disease