Background Chronic kidney disease (CKD) is common in the elderly, but the cause is often not identifiable. Some posit that age-related reductions in glomerular filtration rate (GFR) and increases in albuminuria are normal, whereas others suggest that they are a consequence of vascular disease. Study Design Cross-sectional analysis of a substudy of a prospective cohort. Setting & Participants AGES (Age, Gene/Environment Susceptibility)-Reykjavik Study. Predictor Exposure to higher blood pressure in midlife. Outcomes & Measurements Measured GFR using plasma clearance of iohexol and urine albumin-creatinine ratio (ACR). Results GFR was measured in 805 participants with mean age in midlife and late life of 51.0 ±5.8 and 80.8 ±4.0 (SD) years, respectively. Mean measured GFR was 62.4 ±16.5 ml/min/1.73 m2 and median albuminuria was 8.0 (IQR, 5.4–16.5) mg/g. Higher midlife systolic and diastolic blood pressures were associated with lower later life GFR. Associations persisted after adjustment. Higher midlife systolic and diastolic blood pressures were also associated with higher ACR, and associations remained significant even after adjustment. Limitations This is a study of survivors, and people who agreed to participate in this study were healthier than those who refused. Blood pressure may encompass effects of the other risk factors. Results may not be generalizable to populations of other races. We were not able to adjust for measured GFR or albuminuria at the midlife visit. Conclusions Factors other than advanced age may account for the high prevalence of CKD in the elderly. Midlife factors are potential contributing factors to late-life kidney disease. Further studies are needed to identify and treat midlife modifiable factors to prevent the development of CKD.
Dietary supplements are often used by the elderly to improve their nutritional status. However, intake above the recommended dietary levels may be detrimental, and uncertainty exists on the potential health benefits of supplementation in this population. The aim of this study was to describe supplement use among Icelandic older adults and to assess its association with total mortality and CVD-related mortality. This study used data from the Age Gene/Environment Susceptibility-Reykjavik study, which recruited 5764 participants aged 66–98 years in 2002–2006. Intake of vitamins and minerals from dietary supplements was estimated from interviews. Hazard ratios (HR) for mortality were estimated in multivariate analyses with follow-up ending in 2009. The results showed that most (77 %) of the participants used supplements. Overall, the consumption of vitamins and minerals from supplements was moderate although 22 and 14% of users exceeded the upper recommended intake levels for vitamin B6 and Zn, respectively. Supplement users followed in general a healthier lifestyle than non-users. There were 1221 deaths including 525 CVD-related deaths during the follow-up period. When comparing multivitamin users with non-users in multivariable models, no associations with total mortality (HR 0·91; 95% CI: 0·77, 1·08) or CVD-related mortality (HR 0·91; 95% CI 0·70, 1·18) were observed. In conclusion, users of supplements generally lead healthier lifestyles than non-users and supplements did not confer any added advantage or harm relative to mortality risk. However, the intake of vitamin B6 and Zn from dietary supplements exceeded the recommended daily intake for almost a quarter of the supplement users.
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