Chronic Kidney Disease and End-Stage Renal Disease in the Elderly Population: Current Prevalence, Future Projections, and Clinical Significance

Stevens, Lesley A.; Viswanathan, Gautham; Weiner, Daniel E.

doi:10.1053/j.ackd.2010.03.010

Cited by 225 publications

(170 citation statements)

References 56 publications

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“…42 Patients with kidney disease have progressive injury to multiple organs, among them the cardiovascular system, resulting in a mortality rate which is ten times that of age-matched controls, resulting in effective accelerated BASIC RESEARCH www.jasn.org aging. 14,43 Interestingly, systemic inflammation also promotes cardiovascular morbidity and mortality and has been associated with other age-dependent diseases such as osteoporosis and dementia. 44,45 Locally, a reduction of Klotho expression contributed to progression of kidney failure; although its overexpression ameliorated renal injury in a mouse model.…”

Section: Discussionmentioning

confidence: 99%

The Inflammatory Cytokines TWEAK and TNFα Reduce Renal Klotho Expression through NFκB

Moreno

Izquierdo²,

Sanchez-Niño³

et al. 2011

Journal of the American Society of Nephrology

349

297

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Proinflammatory cytokines contribute to renal injury, but the downstream effectors within kidney cells are not well understood. One candidate effector is Klotho, a protein expressed by renal cells that has antiaging properties; Klotho-deficient mice have an accelerated aging-like phenotype, including vascular injury and renal injury. Whether proinflammatory cytokines, such as TNF and TNF-like weak inducer of apoptosis (TWEAK), modulate Klotho is unknown. In mice, exogenous administration of TWEAK decreased expression of Klotho in the kidney. In the setting of acute kidney injury induced by folic acid, the blockade or absence of TWEAK abrogated the injury-related decrease in renal and plasma Klotho levels. TWEAK, TNF␣, and siRNA-mediated knockdown of IB␣ all activated NFB and reduced Klotho expression in the MCT tubular cell line. Furthermore, inhibition of NFB with parthenolide prevented TWEAK-or TNF␣-induced downregulation of Klotho. Inhibition of histone deacetylase reversed TWEAKinduced downregulation of Klotho, and chromatin immunoprecipitation showed that TWEAK promotes RelA binding to the Klotho promoter, inducing its deacetylation. In conclusion, inflammatory cytokines, such as TWEAK and TNF␣, downregulate Klotho expression through an NFB-dependent mechanism. These results may partially explain the relationship between inflammation and diseases characterized by accelerated aging of organs, including CKD.

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Section: Discussionmentioning

confidence: 99%

The Inflammatory Cytokines TWEAK and TNFα Reduce Renal Klotho Expression through NFκB

Moreno

Izquierdo²,

Sanchez-Niño³

et al. 2011

Journal of the American Society of Nephrology

349

297

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“…Although patients with ESRD have received intensive attention for this reason, the prevalence of ESRD has not decreased; rather, it has continued to grow at a rate of approximately 3% per year (3). This trend is much more prominent in elderly patients, who make up to half of the dialysis population (4). The elderly have a higher prevalence of comorbidities, which increases the burden of dialysis via a substantially higher mortality rate compared with that in their younger counterparts (5,6).…”

Section: Introductionmentioning

confidence: 97%

Dialysis Modality and Mortality in the Elderly

Han

Park

Kang³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Identifying the appropriate choice between hemodialysis (HD) and peritoneal dialysis (PD) is an unresolved issue in elderly patients with ESRD, who are at high risk for death but have a low chance of receiving kidney transplantation.Design, setting, participants, & measurements Data on 13,065 incident dialysis Korean patients (age$65 years) receiving HD (n=10,675) or PD (n=2390) were obtained from the Korean Health Insurance dataset. Multiple statistical approaches, including the multivariate Cox model, were used to compare mortality between Korean patients receiving PD and those receiving HD. Subsequently, meta-analysis of previous comparison studies (published since the year 2000; population-based studies) and the Korean dataset was performed.Results During a mean duration of 1.861.3 years (maximum of 5 years), the Korean PD group had a higher mortality rate than the Korean HD group (hazard ratio [HR], 1.20 [95% confidence interval (95% CI), 1.13 to 1.28]; P,0.001 by multivariate Cox model). The discrepancy between the two modalities was greater in the presence of certain conditions, such as diabetes mellitus or longer dialysis duration. In the meta-analysis, 15 studies involving .631,421 elderly patients were reviewed. Compared with HD, the pooled HR with PD was 1.10 (95% CI, 1.01 to 1.20). When the meta-analysis was stratified by confounding factors, the survival benefit from HD was particularly strong in subgroups that had diabetes mellitus, had long dialysis duration (.1 year), or contained cohorts starting dialysis in the 1990s.Conclusions A meta-analysis that included results in Korean patients suggests a higher risk for death in elderly patients receiving PD than in those receiving HD.

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“…Still, it is only recently that much consideration has been given to the bioavailability of phosphorus (31,34,48). Because both phosphorus intake and kidney disease are increasing in the U.S. diet and around the world, it is likely that consideration of these complex balances will become more important for the general population (49).…”

Section: Data Needs and Study Designs For Accurate Estimates Of Totalmentioning

confidence: 99%

Assessing the Health Impact of Phosphorus in the Food Supply: Issues and Considerations

Calvo

Moshfegh

Tucker

2014

Advances in Nutrition

156

106

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The Western dietary pattern of intake common to many Americans is high in fat, refined carbohydrates, sodium, and phosphorus, all of which are associated with processed food consumption and higher risk of life-threatening chronic diseases. In this review, we focus on the available information on current phosphorus intake with this Western dietary pattern, and new knowledge of how the disruption of phosphorus homeostasis can occur when intake of phosphorus far exceeds nutrient needs and calcium intake is limited. Elevation of extracellular phosphorus, even when phosphorus intake is seemingly modest, but excessive relative to need and calcium intake, may disrupt the endocrine regulation of phosphorus balance in healthy individuals, as it is known to do in renal disease. This elevation in serum phosphate, whether episodic or chronically sustained, may trigger the secretion of regulatory hormones, whose actions can damage tissue, leading to the development of cardiovascular disease, renal impairment, and bone loss. Therefore, we assessed the health impact of excess phosphorus intake in the context of specific issues that reflect changes over time in the U.S. food supply and patterns of intake. Important issues include food processing and food preferences, the need to evaluate phosphorus intake in relation to calcium intake and phosphorus bioavailability, the accuracy of various approaches used to assess phosphorus intake, and the difficulties encountered in evaluating the relations of phosphorus intake to chronic disease markers or incident disease. Adv. Nutr. 5: 104-113, 2014.

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Chronic Kidney Disease and End-Stage Renal Disease in the Elderly Population: Current Prevalence, Future Projections, and Clinical Significance

Cited by 225 publications

References 56 publications

The Inflammatory Cytokines TWEAK and TNFα Reduce Renal Klotho Expression through NFκB

The Inflammatory Cytokines TWEAK and TNFα Reduce Renal Klotho Expression through NFκB

Dialysis Modality and Mortality in the Elderly

Assessing the Health Impact of Phosphorus in the Food Supply: Issues and Considerations

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