Renal impairment and moderate alcohol consumption in the elderly. Results from the Italian Longitudinal Study on Aging (ILSA)

Abstract

Objective: The influence of moderate alcohol consumption on renal function is not clear in elderly people. The aim of the present study was to investigate the relationship between alcohol consumption and renal function, expressed as serum creatinine levels and glomerular filtration rates (GFR), in an elderly population. Design: Perspective cohort study. Setting: Population-based study on an elderly Italian population. Subjects: A sample of 3404 Italian people (1619 women and 1785 men), aged 65-84 years, from the Italian Longitudinal Study on Aging (ILSA). Results: Prevalence and cumulative risk of impaired renal function (defined as GFR # 60 ml/min) were estimated by sex and alcohol consumption groups. Logistic regression analysis adjusting for confounders (age, education, smoking, BMI and medications) and intermediate factors (blood cholesterol and fibrinogen, systolic hypertension and diabetes) showed that alcohol consumption level was not significantly related to the prevalence of mild renal impairment in elderly women. In men, both prevalence and incidence results seemed to suggest an inverse linear relationship between moderate alcohol consumption and the risk of mild renal impairment. A U-shaped association was shown for women at the incidence phase, suggesting a higher risk of developing renal impairment for women who drink more than 24 g alcohol/d. Conclusions: Our results suggest that, in accordance with the recommendations on alcohol consumption in the elderly, moderate quantities of alcohol are not injurious to renal function in elderly men.

Alcohol Consumption Can be a “Double-Edged Sword” for Chronic Kidney Disease Patients

“…Sex, age, primary diseases, initial GFR, individual differences, and dietary structure can all influence the results of a study. Although associations between alcohol consumption and CKD risk did not show significant interactions with age, sex, smoking, hypertension, or hypercholesterolemia [80], many studies still found that the effect of alcohol consumption on CKD varies with sex [13,14,76,90], as it appears that sex may be a significant determinant of the effects of alcohol on GFR [50,91].…”

Alcohol Drinking and the Risk of Chronic Kidney Damage: A Meta‐Analysis of 15 Prospective Cohort Studies

“…Three studies included only male participants (Reynolds et al., ; Sato et al., ; Schaeffner et al., ), 1 study included only female subjects (Knight et al., ), and another 11 studies included both male and female participants. Two studies assessed the association between drinking and chronic kidney damage stratified by sex (Buja et al., ; Yamagata et al., ); thus, we regarded one study as 2 independent studies to extract data. The reference groups were non‐drinkers except in 4 studies (Schaeffner et al., ; Shankar et al., ; Wakasugi et al., ; White et al., ) which selected subjects with lower alcohol drinking as reference group (mean level of alcohol drinking < 10 g/d).…”

“…Nine studies defined the dose of alcohol intake by drinking frequency (Dunkler et al., ; Foster et al., ; Hu et al., ; Koning et al., ; Menon et al., ; Reynolds et al., ; Schaeffner et al., ; Shankar et al., ; Stengel et al., ), and another 6 studies assessed alcohol drinking by the dose of alcohol. Of all the studies, 2 studies chose ESRD as an outcome (Reynolds et al., ; Stengel et al., ), 8 studies chose declined GFR (Buja et al., ; Foster et al., ; Hu et al., ; Knight et al., ; Menon et al., ; Sato et al., ; Schaeffner et al., ; Shankar et al., ), 1 study chose proteinuria (Wakasugi et al., ), and 4 studies included both declined GFR and proteinuria as outcomes (Dunkler et al., ; Koning et al., ; White et al., ; Yamagata et al., ). The major adjusted confounders included age; body mass index; physical activity; smoking; and some basic diseases, such as hypertension, diabetes, and hypercholesterolemia; and the baseline information.…”

“…. The RRs of individual studies varied from 0.72 to 1.18, among which 4 studies showed the reduced risk of chronic kidney damage from alcohol drinking (Dunkler et al., ; Hu et al., ; Schaeffner et al., ; Yamagata et al., ) and another 9 studies supported the insignificant association between low alcohol intake and the risk of chronic kidney damage (Buja et al., ; Foster et al., ; Knight et al., ; Koning et al., ; Menon et al., ; Sato et al., ; Stengel et al., ; Yamagata et al., ). The pooled risk estimates showed that subjects with low alcohol drinking had 12% lower risk of chronic kidney damage compared with the reference group (RR = 0.88, 95% CI: 0.83 to 0.93), and no heterogeneity was observed ( I 2 = 29.5%, P = 0.149).…”

“…Additionally, a large cohort study reported that higher alcohol/salad pattern scores were associated with lower risk of ESRD in CKD patients (hazard risks [HR] comparing the fourth to the first quartile, 0.88) (Gutierrez et al., ). Conversely, other studies had deduced no associations between alcohol drinking and CKD or ESRD (Buja et al., ; Foster et al., ; Knight et al., ; Menon et al., ; Sato et al., ; Shankar et al., ; Stengel et al., ; Wakasugi et al., ; Yamagata et al., ). The difference in the size of samples, follow‐up duration, race and gender of subjects, the definition of exposure, and outcome among different studies might contribute to these discrepancies.…”