Demographic, clinical characteristics and cardiovascular disease burden in a Portuguese cohort of older chronic kidney disease patients

Abstract

Introduction: Chronic kidney disease (CKD) is an independent risk factor for several unfavorable outcomes including cardiovascular disease (CVD), particularly in the elderly, who represent the most rapidly growing segment of the end-stage kidney disease (ESKD) population. Portugal has the highest European unadjusted incidence and prevalence rates of ESKD. In 2012, we started to follow a cohort of elderly CKD patients, we describe their baseline characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during 2012 were enrolled. Baseline data included: demographic, CKD stage, medication, comorbid conditions. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula. Results: A total of 416 patients, 50% referred by primary care physicians, aged 77 ± 7 years, 52% male, with a median eGFR of 32 mL/min/1.73m2 participated in the study. Fifty percent had diabetes (DM), 85% dyslipidemia, 96% hypertension; 26% were current/former smokers, and 24% had a body mass index > 30 kg/m2. The prevalence of CVD was 62% and higher in stage 4-5 patients; in diabetics, it gradually increased with CKD progression (stage 3a < stage 3b < stage 4-5) (39, 58, 82%; p < 0.001). Conclusions: At baseline, our CKD elderly cohort had a higher burden of CVD. The prevalence of CVD was greater than in other European CKD cohorts. Lower level of eGFR was associated with a greater burden of CVD and was more pronounced in diabetics, highlighting the importance of strategically targeting cardiovascular risk reduction in these patients.

RENA Study: Cross-Sectional Study to Evaluate CKD Prevalence in Portugal

“…As described by other studies into the prevalence of CKD [20][21][22] and by studies that characterize the CKD population in specific contexts [23][24][25], the population with confirmed CKD from our study has more people older than 60 years and presents a higher prevalence of hypertension, dyslipidemia, DM, and obesity than the population without CKD. In fact, CKD is knowingly associated with independent cardiovascular risk factors, more common in this population and also associated with greater medication burden, high healthcare costs, and poorer survival [24,26].…”

“…As the samples were similar regarding sex, age class distribution, and comorbidities (65% of women in the RENA study vs. 60% in the PREVADIAB study, red, very high risk. eGFR was estimated by the CKD-EPI equation [23]. CKD, chronic kidney disease; ACR, albumin-to-creatinine ratio; eGFR, estimated glomerular filtration rate.…”

Nephrology and intervention in the community – On the need for improving the interplay between nephrology centers and primary care in Portugal

“…Portugal has the highest incidence of CKD in Europe and the incidence and prevalence of advanced CKD requiring renal replacement therapy are higher than other occidental European countries. In a study of patients referred to the nephrology outpatient clinic at Centro Hospitalar Universitário do Porto during 2012, 49% of the new referred patients were older than 65 years of age, with many comorbidities, namely hypertension (96%), diabetes mellitus (50%), coronary artery disease (25%), cerebrovascular disease (24%), and 38% of them had functional dependence 6 . The high prevalence of CKD in an aging population, with multiple comorbidities and mobility difficulties implies changes in policy healthcare, with strategies to prevent and control the disease development and adjustment of human resources.…”

<br/>VERSÃO REDUZIDA DA ESCALA PORTUGUESA POSITIVE AND NEGATIVE AFFECT SCHEDULE EM PESSOAS SUBMETIDAS A HEMODIÁLISE<br/>

“…A doença renal crónica (DRC) é fator de risco independente para vários desfechos desfavoráveis, incluindo doença cardiovascular, especialmente em idosos, em que se verifica um crescimento mais rápido da população com doença renal terminal (DRT). Portugal tem a maior incidência europeia não-ajustada e a maior prevalência de DRT (1) .…”