Prevalence of CKD and Comorbid Illness in Elderly Patients in the United States: Results From the Kidney Early Evaluation Program (KEEP)

Stevens, Lesley A.; Li, Suying; Wang, Changchun; Huang, Cindy; Becker, Bryan N.; Bomback, Andrew S.; Brown, Wendy Weinstock; Burrows, Nilka Ríos; Jurkovitz, Claudine; McFarlane, Samy I.; Norris, Keith C.; Shlipak, Michael G.; Whaley‐Connell, Adam; Chen, Shu‐Cheng; Bakris, George L.; McCullough, Peter A.

doi:10.1053/j.ajkd.2009.09.035

Cited by 238 publications

(151 citation statements)

References 35 publications

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“…Since chronic vascular disease occurs through general mechanisms that act in all circulatory beds, renal vascular dysfunction may simply serve as a convenient, quantifiable surrogate for systemic vascular disease. It has been proposed that Notes: *Data taken from published paper from Stevens et al 10 for comparison. CKD prevalence estimated based on MDRD study equation using one eGFR value.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of various comorbidities among veterans with chronic kidney disease and its comparison with other datasets

Patel

Golzy

Nainani³

et al. 2015

Renal Failure

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Chronic kidney disease (CKD) has a complicated interrelationship with various comorbidities. The purpose of this study was to describe the prevalence of various comorbidities among veterans with CKD and compare it with other datasets like Kidney Early Evaluation Program (KEEP), National Health and Nutrition Examination Survey (NHANES) and Medicare. Patients who had at least one outpatient visit in year 2007 (1 January 2007 to 31 December 2007) were included in the study (n ¼ 75,787). Glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease (MDRD) study equation. CKD prevalence was calculated based on one or two serum creatinine values at least 3 months apart. Demographic data were obtained including age, gender, race, weight, height and body mass index (BMI). The prevalence of various comorbidities was also collected based on ICD 9 codes from the problem list. The prevalence of CKD among veterans was 47.3%, much higher than estimated in the US population. Patients with CKD were more likely to have any vascular disease (36.89% vs. 14.87%), diabetes (34.18% vs. 17.83%), hypertension (86.65% vs. 57.56%), and cancer (18.69% vs. 9.23%). Irrespective of age, the prevalence of vascular disease was much higher among veterans with CKD. The prevalence of coronary artery disease, peripheral vascular disease, and cancer was much higher among elderly veterans with CKD as compared to other datasets. CKD is a growing endemic associated with a high frequency of concomitant chronic illnesses. Public health resources should be applied for early recognition and risk modification of CKD. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Prevalence of various comorbidities among veterans with chronic kidney disease and its comparison with other datasets

Patel

Golzy

Nainani³

et al. 2015

Renal Failure

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“…The prevalence of diabetes, hypertension, dyslipidemia, coronary artery disease, congestive heart failure, cerebrovascular disease, peripheral vascular disease, cancer and chronic kidney disease with its complication are higher in elderly patients especially those older than 75 years old (11). A significant number of elderly patients use anticoagulant for cardiovascular and other chronic disease (12). These factors lead to the worsening of the cardiopulmonary reserve and increasing of anesthetic risks for operation in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of percutaneous nephrolithotomy: Comparison of elderly and younger patients

2013

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Background and purpose: Percutaneous nephrolithotomy (PCnL) in elderly patients is challenging due to the high prevalence of comorbidity and single kidney. We compared the results and complications of patients who were submitted to PCnL according to age (higher than and lower than 65 years old). Materials and Methods: A total of 61 patients aged more than 65 years old (group I) and 385 patients aged 65 years old or less (group II) were treated with PCnL. PCnL was performed by a standard technique under fluoroscopic guidance. The operative time, length of hospital stay, success rate, auxiliary treatment and complications of both groups were compared. Results: Patients older than 65 years old (group I) had more comorbidities mainly diabetes mellitus, hypertension and higher level of ASA classification (P < 0.001). The success rate was 85.24% and 86.24% of groups I and II, respectively. Four patients (6.56%) of group I and 55 patients (14.29%) of group II needed auxiliary treatment (P = 0.098). Among the complications, only sepsis was significantly higher in group I (6.56% of group I and 1.3% of group II, P = 0.007). The operative time, success rate, hospital stay and complications except sepsis episode did not significantly differ between the two groups. Conclusion: Percutaneous nephrolithotomy is effective and safe in elderly patients even though with more comorbidities. Sepsis is the only more frequent common complication following PCnL in elderly.

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“…CKD affects a large segment of the aged population (1), and older adults may be more vulnerable to the metabolic and hormonal disturbances associated with kidney disease. Although CKD is known to affect cardiovascular disease risk, in older adults it has also been associated with noncardiovascular complications, poor physical functioning, and unsuccessful aging (2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Kidney Function and Prevalent and Incident Frailty

Dalrymple¹,

Katz²,

Rifkin³

et al. 2013

Clinical Journal of the American Society of Nephrology

129

118

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SummaryBackground and objectives Kidney disease is associated with physiologic changes that may predispose to frailty. This study sought to investigate whether lower levels of kidney function were associated with prevalent or incident frailty in Cardiovascular Health Study (CHS) participants.Design, setting, participants, & measurements CHS enrolled community-dwelling adults age $65 years between 1989-1990 and 1992-1993. To examine prevalent frailty, included were 4150 participants without stroke, Parkinson disease, prescribed medications for Alzheimer disease or depression, or severely impaired cognition. To examine incident frailty, included were a subset of 3459 participants without baseline frailty or development of exclusion criteria during follow-up. The primary predictor was estimated GFR (eGFR) calculated using serum cystatin C (eGFR cys ). Secondary analyses examined eGFR using serum creatinine (eGFR SCr ). Outcomes were prevalent frailty and incident frailty at 4 years of follow-up. Frailty was ascertained on the basis of weight loss, exhaustion, weakness, slowness, and low physical activity.Results The mean age was 75 years and the median eGFR cys was 73 ml/min per 1.73 m 2 . Among participants with an eGFR cys ,45 ml/min per 1.73 m 2 , 24% had prevalent frailty. In multivariable analysis and compared with eGFR cys $90 ml/min per 1.73 m 2 , eGFR cys categories of 45-59 (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.17 to 2.75) and 15-44 (OR, 2.87; 95% CI, 1.72 to 4.77) were associated with higher odds of frailty, whereas 60-75 (OR, 1.14; 95% CI, 0.76 to 1.70) was not. In multivariable analysis, eGFR cys categories of 60-75 (incidence rate ratio [IRR], 1.72; 95% CI, 1.07 to 2.75) and 15-44 (IRR, 2.28; 95% CI, 1.23 to 4.22) were associated with higher incidence of frailty whereas 45-59 (IRR, 1.53; 95% CI, 0.90 to 2.60) was not. Lower levels of eGFR SCr were not associated with higher risk of prevalent or incident frailty.Conclusions In community-dwelling elders, lower eGFR cys was associated with a higher risk of prevalent and incident frailty whereas lower eGFR SCr was not. These findings highlight the importance of considering non-GFR determinants of kidney function.

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Prevalence of CKD and Comorbid Illness in Elderly Patients in the United States: Results From the Kidney Early Evaluation Program (KEEP)

Cited by 238 publications

References 35 publications

Prevalence of various comorbidities among veterans with chronic kidney disease and its comparison with other datasets

Prevalence of various comorbidities among veterans with chronic kidney disease and its comparison with other datasets

Outcomes of percutaneous nephrolithotomy: Comparison of elderly and younger patients

Kidney Function and Prevalent and Incident Frailty

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