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

Docherty, N. G., Delles, C. , D’Haese, P., Layton, A. T., Martínez-Salgado, C., Vervaet, B. A. and López-Hernández, F. J. (2021) Haemodynamic frailty – A risk factor for acute kidney injury in the elderly. Ageing Research Reviews, 70, 101408. (doi: 10.1016/j.arr.2021.101408) (PMID:34271185)

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Abstract

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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Delles, Professor Christian
Authors: Docherty, N. G., Delles, C., D’Haese, P., Layton, A. T., Martínez-Salgado, C., Vervaet, B. A., and López-Hernández, F. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Ageing Research Reviews
Publisher:Elsevier
ISSN:1568-1637
ISSN (Online):1872-9649
Published Online:13 July 2021
Copyright Holders:Crown Copyright © 2021
First Published:First published in Ageing Research Reviews 70:101408
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science