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 |
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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 > School of Cardiovascular & Metabolic Health |
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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