10-Year Renal Function Trajectories in Community-Dwelling Older Adults: Exploring the Risk Factors for Different Patterns

Abstract

Longitudinal changes of renal function help inform patients’ clinical courses and improve risk stratification. Rare studies address risk factors predicting changes in estimated glomerular filtration rate (eGFR) over time in older adults, particularly of Chinese ethnicity. We identified prospectively enrolled community-dwelling older adults (≥65 years) receiving annual health examinations between 2005 and 2015 with serum creatinine available continuously in a single institute, and used linear regression to derive individual’s annual eGFR changes, followed by multivariate logistic regression analyses to identify features associated with different eGFR change patterns. Among 500 elderly (71.3 ± 4.2 years), their mean annual eGFR changes were 0.84 ± 1.67 mL/min/1.73 m2/year, with 136 (27.2%) and 238 (47.6%) classified as having downward (annual eGFR change <0 mL/min/1.73 m2/year) and upward eGFR (≥1 mL/min/1.73 m2/year) trajectories, respectively. Multivariate logistic regression showed that higher age (odds ratio (OR) 1.08), worse renal function (OR 13.2), and more severe proteinuria (OR 9.86) or hematuria (OR 3.39) were predictive of a declining eGFR while greater waist circumference (OR 1.06) and higher leukocyte counts (OR 1.21) were predictive of an uprising 10-year eGFR. These findings elucidate important features associated with geriatric renal function variations, which are expected to improve their renal care.

Predictors of rapid progression of estimated glomerular filtration rate among persons living with diabetes and/or hypertension in Ghana: Findings from a multicentre study

“…Even so, we observed a significant burden of rapid declines in kidney function among Ghanaians living with hypertension and or diabetes compared with previously cited studies. [17][18][19] In the present study, we found increasing age, partial health insurance coverage for medications, history of smoking, and prescription of ARB were associated with a rapid decline in eGFR while patients on Metformin had a slow progression. Each 10-year rise in age was associated with 20% increased odds of faster progression of eGFR.…”

“…In a retrospective study in the USA among non‐proteinuric hypertensive patients with and without diabetes, the fraction of patients with a decline in eGFR > 3.5 ml/min/year was 7.2% among patients with diabetes and 6.0% among those without diabetes 18 . Among community‐dwelling older adults aged > 65years of Chinese ethnicity with or without co‐morbidities followed up for 10 years, 1.8% of them had eGFR decline ‐4 ml/min/1.73 m 2 per year 19 . Admittedly these cited studies involved a heterogeneous study sample and eGFR decline rates were different across the studies.…”

“… 18 Among community‐dwelling older adults aged > 65years of Chinese ethnicity with or without co‐morbidities followed up for 10 years, 1.8% of them had eGFR decline ‐4 ml/min/1.73 m 2 per year. 19 Admittedly these cited studies involved a heterogeneous study sample and eGFR decline rates were different across the studies. We choose a less conservative cut‐off of ≥5 ml/min/1.73 m 2 per year.…”

“…Even so, we observed a significant burden of rapid declines in kidney function among Ghanaians living with hypertension and or diabetes compared with previously cited studies. 17 , 18 , 19 …”

Frailty Predicts an Increased Risk of End-Stage Renal Disease with Risk Competition by Mortality among 165,461 Diabetic Kidney Disease Patients

“…Researchers have proposed several reasons potentially responsible for earlier initiation of dialysis in frail patients; components of frailty, including malnutrition related weight loss and functional decline, might prompt nephrologists to consider dialysis earlier than expected for relieving these symptoms which will otherwise be attributed to uremic status [25]. Alternatively, low muscle origin creatinine generation and hypocreatininemia can accompany sarcopenia, a frequent companion of frailty, leading to difficulty in estimating true GFR level [26,27]. The relationship between early dialysis initiation and poorer survival among CKD patients may be confounded at least partially by the fact that frail CKD patients are dialyzed earlier than non-frail ones [28].…”