Associated factors related to chronic kidney disease progression in elderly patients

Abstract

Background Chronic Kidney Disease (CKD) is a worldwide public health problem. The prevalence of CKD is rising especially in elderly, as consequence of population-ageing related to socioeconomic development and better life expectancy. There are scarce studies evaluating CKD progression and its associated factors in elderly patients. Methods This is a retrospective observational study including 340 patients (≥ 65 years old) CKD stages 3a–5 non-dialysis, incidents in an outpatient CKD clinic, followed by 2.1 years. CKD progression was assessed by the slope of eGFR calculated by CKD-EPI and BIS 1 equations. The patients were divided in progressor and non-progressor groups (eGFR slope < or ≥ 0 mL/min/1.73 m 2 /year, respectively). Results Kidney function declined in 193 (57%) patients. In this group, the progression rate was -2.83 (-5.1 / -1.1) mL /min /1.73 m 2 /year. Compared to non progressor, the progressor patients were younger [72 (69–78) vs. 76 (69–80) years; p = 0.02]; had higher proportion of diabetic nephropathy, higher serum phosphorus [3.8 (3.3–4.1) vs. 3.5 (3.9–4.1) mg/dL; p = 0.04] and proteinuria [0.10 (0–0.9 vs. 0 (0–0.3)] g/L; p = 0.007)] at the admission. In the logistic regression analysis adjusted for gender and eGFR, proteinuria was independently associated with CKD progression [OR (Odds Ratio) (1.83; 95% CI, 1.17–2.86; p < 0.01)]. Conclusion CKD progression was observed in the majority of elderly CKD patients and proteinuria was the most important factor associated to the decline of kidney function in this population.

Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation

“…Additionally, the high prevalence of abnormal kidney function among diabetic patients has been consistently reported in populations living in the United States [62], United Arab Emirates [64], Japan [65], Palestine [66], China [63, 67], Taiwan [68], and Europe [69–71]. Moreover, T2D probably predicts progression of chronic kidney disease, and the presence of diabetic kidney disease seems to be associated with poor cardiovascular risk profile, especially in elderly individuals [71, 72]. Furthermore, in accordance with DOACs' pharmacology, patients with severe renal impairment were excluded from phase III clinical trials with DOACs [27, 40, 52, 53, 57].…”

Urinary excretion of electrolytes and their correlation with clinical parameters in chronic kidney disease

“…Related research found that renal dysfunction in elderly patients with CKD is one of the important reasons for the decline in the presence of high levels of proteinuria. 10 The 24 hour urine electrolyte research on CKD patients has become a major hot spot. This study was aimed to analyze the relevance of clinical features to urine electrolytes; urine protein was the focus of analysis.…”

Does delivering more dialysis improve clinical outcomes? What randomized controlled trials have shown

“…The slope of kidney function decline can be heterogeneous. Especially among older adults a large fraction exhibits slower progression of RKF [59] potentially making them good candidates for incremental haemodialysis. An incremental, stepped haemodialysis regimen with a scheduled transition from twice-to thrice-weekly is believed to offer the body more time to adapt to the new treatment compared to the sudden start of standard haemodialysis, the prescription of which is fundamentally empirical [60].…”