Markers of kidney function in the elderly in relation to the new CKD-EPI formula for estimation of glomerular filtration rate

Abstract

IntroductionNeutrophil gelatinase-associated lipocalin (NGAL) has been recently proved useful in the quantitation of chronic kidney disease (CKD). The aim of the study was to assess prevalence of CKD according to the Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae in 412 patients with normal serum creatinine and markers of kidney function/injury such as NGAL, cystatin C, and kidney injury molecule-1 (KIM-1) in these patients in relation to age (below and over 65 years).Material and methodsWe included in the study 1005 patients with coronary artery disease and normal serum creatinine. However, markers of kidney function/injury were assessed in 412 patients. The NGAL, cystatin C and KIM-1, were assessed using commercially available kits.ResultsPatients over 65 years had significantly lower estimated glomerular filtration rate (eGFR) than their younger counterparts despite identical creatinine. They also had significantly lower haematocrit, despite similar Hb, lower platelet count, higher serum fibrinogen, higher systolic (SBP) and lower diastolic blood pressure, higher serum NGAL and cystatin C, but similar urinary NGAL and KIM-1. Serum NGAL correlated with age, haematocrit, leukocyte, platelet and erythrocyte count, eGFR, creatinine, fasting glucose, HbA1c, fibrinogen, SBP, and diabetes duration. In multiple regression analysis kidney function (eGFR, creatinine clearance or creatinine), cystatin C and SBP were predictors of serum NGAL.ConclusionsIn our study we found a very high prevalence of CKD up to 61% in elderly patients with coronary artery disease and normal serum creatinine. Neutrophil gelatinase-associated lipocalin could be a sensitive marker of kidney function, particularly in elderly patients with another risk factor for kidney damage, i.e. hypertension.

Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study

“…These data might partly explain the greater reduction in CVD events in elderly patients, who had worse renal function than the younger ones, but also the greater improvement in eGFR, closely related to CVD event reduction [19–25]. Of note, clinicians should evaluate kidney function using certain formulae including MDRD, Cockcroft-Gault or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), as CKD patients may have normal serum creatinine levels, especially in the elderly population [26]. …”

Highlights of the mechanistic and therapeutic cachexia and sarcopenia research 2010 to 2012 and their relevance for cardiology

“…Patients with chronic heart failure were recently found to be affected by muscle wasting fulfilling the criteria of sarcopenia in 19.5% of a prospectively enrolled cohort of patients with stable disease [36]. Cachexia, on the other hand, is frequent in chronic kidney disease (CKD) [9,[37][38][39] and as part of the cardio-renal syndrome also affecting heart failure (HF) patients regularly [40][41][42]. Cachexia is also a significant problem in advanced heart disease itself [43] and related to comorbidities such as diabetes mellitus and chronic inflammation [44].…”

Statins in patients with chronic kidney disease – an attempt at recommendations

“…As mentioned above, studies in ESRD patients on dialysis gave conflicting, mostly negative results, and no significant effects were found in the 4D (Die Deutsche Diabetes Dialyse) (except for the fatal stroke and cardiac events) and AURORA (A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) studies 18,19 . Even in the SHARP (Study of Heart and Renal Protection) study despite significant reduction in major atherosclerotic (by 17%; p ¼ 0.0022) and vascular (by 15.3%, p ¼ 0.0012) events, there was only an insignificant trend toward reducing CV events in dialysis patients; this trial also had several design limitations [18][19][20][21][22][23] . Taking into account the existing doubts we performed three meta-analyses to evaluate the impact of statin therapy on: (1) lipid parameters, (2) CV events and death from all causes, and (3) renal outcomes.…”