Exploration of the Relationship Among Key Risk Factors of Acute Kidney Injury for Elderly Patients Considering Covid-19

Yen-Ching Chuang; Tao-Hsin Tung; Jau-Yuan Chen; Ching-Wen Chien; Kao-Yi Shen

doi:10.3389/fmed.2021.639250

Exploration of the Relationship Among Key Risk Factors of Acute Kidney Injury for Elderly Patients Considering Covid-19

Front Med (Lausanne). 2021 Jul 22:8:639250. doi: 10.3389/fmed.2021.639250. eCollection 2021.

Authors

Yen-Ching Chuang¹, Tao-Hsin Tung², Jau-Yuan Chen³, Ching-Wen Chien⁴, Kao-Yi Shen⁵

Affiliations

¹ Institute of Public Health & Emergency Management, Taizhou University, Taizhou, China.
² Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
³ Department of Family Medicine, Linkou Chang-Gung Memorial Hospital and Chang-Gung University, Taoyuan, Taiwan.
⁴ Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China.
⁵ Department of Banking and Finance, Chinese Culture University, Taipei, Taiwan.

Abstract

Background: Previous systematic reviews and meta-analyses supported the relationship between frailty and risk of acute kidney injury (AKI) in elderly patients. However, few studies evaluated proactive management to wear down AKI risk in such frail populations. Purpose: To understand how AKI risk factors might influence each other and to identify the source factors for clinical decision aids. Methods: This study uses the decision-making trial and evaluation laboratory (DEMATEL) method to establish influential network-relationship diagrams (INRDs) to form the AKI risk assessment model for the elderly. Results: Based on the DEMATEL approach, the results of INRD identified the six key risk factors: comorbidity, malignancy, diabetes, creatinine, estimated glomerular filtration rate, and nutritional assessment. (The statistical significance confidence is 98.423%, which is higher than 95%; the gap error is 1.577%, which is lower than 5%). After considering COVID-19 as an additional risk factor in comorbidity, the INRD revealed a similar influential relationship among the essential aspects. Conclusion: While evaluating the geriatric population, physicians need to pay attention to patients' comorbidities and nutritional assessment; also, they should note patients' creatinine values and glomerular filtration rate. Physicians could establish a preliminary observation index and then design a series of preventive guidelines to reduce the incidence of AKI risk for the elderly.

Keywords: acute kidney injury (AKI); coronavirus disease 2019 (Covid-19); decision-making trial and evaluation laboratory (DEMATEL); elderly; frailty; influential network-relation structure; multiple criteria decision-making (MCDM); risk assessment framework.