Progression of kidney dysfunction in the community-dwelling elderly

Hemmelgarn, Brenda R.; Zhang, J.; Manns, Braden; Tonelli, Marcello; Larsen, Erik T.; Ghali, William A.; Southern, Danielle; McLaughlin, Kevin; Mortis, Garth; Culleton, Bruce F.

doi:10.1038/sj.ki.5000270

Cited by 345 publications

(275 citation statements)

References 44 publications

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“…Second, the subsample of 610 participants was not randomly drawn from the entire cohort of 2073 but was asked to have iohexol measured after enrollment in the BIS, potentially introducing selection bias. When the MDRD study equation was used (Appendix Table 6), the prevalence of eGFR less than 60 mL/min per 1.73 m in our iohexol subsample was approximately 7% less than the prevalence rates in other community-dwelling elderly cohorts (7,50). The rate of participants with albuminuria was similar to another representative sample (51).…”

Section: Discussionmentioning

confidence: 51%

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Schaeffner¹,

Ebert²,

Delanaye³

et al. 2012

Ann Intern Med

526

452

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Background: In older adults, current equations to estimate glomerular filtration rate (GFR) are not validated and may misclassify elderly persons in terms of their stage of chronic kidney disease. Objective: To derive the Berlin Initiative Study (BIS) equation, a novel estimator of GFR in elderly participants. Design: Cross-sectional. Data were split for analysis into 2 sets for equation development and internal validation. Setting: Random community-based population of a large insurance company. Participants: 610 participants aged 70 years or older (mean age, 78.5 years). Intervention: lohexol plasma clearance measurement as gold standard. Measurements: GFR, measured as the plasma clearance of the endogenous marker iohexol, to compare performance of existing equations of estimated GFR with measured GFR of the gold standard; estimation of measured GFR from standardized creatinine and cystatin C levels, sex, and age in the learning sample; and comparison of the BIS equations (BIS1: creatinine-based; BIS2: creatinine-and cystatin C-based) with other estimating equations and determination of bias, precision, and accuracy in the validation sample. Results:The new BIS2 equation yielded the smallest bias followed by the creatinine-based BIS1 and CockcroftGault equations. All other equations considerably overestimated GFR. The BIS equations confirmed a high prevalence of persons older than 70 years with a GFR less than 60 mL/min per 1.73 m 2 (BIS1, 50.4%; BIS2, 47.4%; measured GFR, 47.9%). The total misclassification rate for this criterion was smallest for the BIS2 equation (11.6%), followed by the cystatin C equation 2 (15.1%) proposed by the Chronic Kidney Disease Epidemiology Collaboration. Among the creatinine-based equations, BIS1 had the smallest misclassification rate (17.2%), followed by the Chronic Kidney Disease Epidemiology Collaboration equation (20.4%). Limitation: There was no validation by an external data set. Conclusion: The BIS2 equation should be used to estimate GFR in persons aged 70 years or older with normal or mild to moderately reduced kidney function. If cystatin C is not available, the BIS1 equation is an acceptable alternative. Primary Funding Source: Kuratorium für Dialyse und Nierentransplatation (KfH) Foundation of Preventive Medicine.

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Section: Discussionmentioning

confidence: 51%

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Schaeffner¹,

Ebert²,

Delanaye³

et al. 2012

Ann Intern Med

526

452

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“…However, eGFR decreases with aging (21,22). Therefore, adding elderly persons to the traditional CKD screening approach may be efficient in detecting individuals with mildly impaired GFR, but it may not be the most efficient approach to detect CKD cases at increased risk for CKD complications.…”

Section: Discussionmentioning

confidence: 99%

Added Value of Screening for CKD among the Elderly or Persons with Low Socioeconomic Status

Vart¹,

Reijneveld²,

Bültmann³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objective Three screening approaches were compared for their ability to detect CKD cases, and identify patients with CKD who have a higher rate of incident cardiovascular disease (CVD) events and renal function decline. Approach 1 was the traditional CKD screening approach, targeting only individuals with known diabetes, hypertension, or CVD history. Approach 2 was defined as Approach 1+elderly, and Approach 3 as Approach 1+low-socioeconomic status (SES) individuals.Design, setting, participants, & measurements Data on 3411 individuals from the general population in The Netherlands were examined. Individuals aged .60 years were classified as elderly. Persons with low SES was defined as those with primary school or below primary school education. CKD was diagnosed during outpatient clinic visits. Individuals were followed for 9.462.6 years during four screening rounds.Results At baseline, 16%, 29%, and 25% of the general population was to be screened and 36%, 59%, and 51% of the CKD (n=263) cases were detected in Approaches 1, 2, and 3, respectively. The numbers of individuals needed to screen to detect one CKD case were 5.6 in Approach 1 and 6.5 each in Approach 2 and 3. In Approach 2 the hazard ratio for incident CVD events was 1.87 (95% confidence interval [95% CI], 1.35 to 2.61) in detected and 1.92 (95% CI, 1.01 to 3.64) in undetected CKD cases compared with persons without CKD, whereas in Approach 3 these values were 2.31 (95% CI, 1.64 to 3.25) and 1.28 (95% CI, 0.77 to 2.13), respectively. In Approach 2, the rate of renal function decline was 21.37 ml/min per 1.73 m 2 per year in detected and 21.13 ml/min per 1.73 m 2 per year in undetected CKD cases. In Approach 3, these figures were 21.41 and 21.14 ml/min per 1.73 m 2 per year, respectively.Conclusions Adding persons with low SES, rather than adding elderly persons, to the traditional high-risk groups may help detect more persons with CKD who have a higher rate of future CVD events and renal function decline.

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“…The results of small study of the Baltimore Longitudinal Study on Aging also supported the findings, where an average GFR decline was 0.75 mL/min/year in men as evaluated with creatinine clearance (7). Similarly, in a longitudinal community-based study of a 2-year follow up of the elderly Canadians, Hemmelgarn et al reported that the rate of GFR decline was 0.8 mL/min/1.73 m 2 /year in women and 1.4 mL/min/1.73 m 2 /year in men in age Rate of Decline in GFR (mL/min/1.73 m group 66 years or older (about age 76 on average) without diabetes (10). However, these studies had critical disadvantages, because the study was conducted with a cross-sectional design (9) or with small number of subjects (7), and the loss of kidney function was analyzed using dichotomous outcomes (10) or evaluated based on creatinine clearance (7).…”

Section: Discussionmentioning

confidence: 99%

Slower Decline of Glomerular Filtration Rate in the Japanese General Population: A Longitudinal 10-Year Follow-Up Study

et al. 2008

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Progression of kidney dysfunction in the community-dwelling elderly

Cited by 345 publications

References 44 publications

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Added Value of Screening for CKD among the Elderly or Persons with Low Socioeconomic Status

Slower Decline of Glomerular Filtration Rate in the Japanese General Population: A Longitudinal 10-Year Follow-Up Study

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