Association of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults

Bowling, C. Barrett; Bromfield, Samantha G.; Colantonio, Lisandro D.; Gutiérrez, Orlando M.; Shimbo, Daichi; Reynolds, Kristi; Wright, Nicole C.; Curtis, Jeffrey R.; Judd, Suzanne E.; Franch, Harold A.; Warnock, David G.; McClellan, William M.; Muntner, Paul

doi:10.2215/cjn.11111015

Cited by 45 publications

(38 citation statements)

References 31 publications

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“…In a recent report, a higher degree of albuminuria but not eGFR was associated with increased risk for serious falls among Medicare beneficiaries aged ≥65 years, even after adjustment for demographic, comorbid, and fall risk factors [21]. This is consistent with our results as slower gait speed is associated with increased falls risk [22].…”

Section: Discussionsupporting

confidence: 91%

Association of Albuminuria and Estimated Glomerular Filtration Rate with Functional Performance Measures in Older Adults with Chronic Kidney Disease

Wolfgram

Garcia²,

Evans³

et al. 2017

Am J Nephrol

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Background: Chronic kidney disease (CKD) is increasingly common and disproportionately affects older adults. The contribution of kidney disease to the functional impairment noted in the elderly CKD population is unclear. Methods: This is a cross-sectional analysis of a hypertensive cohort of people aged ≥75 years from the Systolic Blood Pressure Intervention Trial. We evaluated estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) as predictors of 3 measures of functional status: EuroQol-5 Dimensional (EQ-5D) score, Falls Efficacy Scale (FES) score, and gait speed. Linear regression models were used to evaluate the associations between our independent variables and outcome measures. Results: Our analysis included 2,620 participants, mean age of 79.9 (4.0) years. Unadjusted models showed that lower eGFR level and higher UACR level were associated with lower EQ-5D (p < 0.001 for both) and slower gait speed (p < 0.001 for both) and worse scores on FES (p = 0.032 and p = 0.039). In the fully adjusted models, higher levels of UACR remained significantly associated with lower EQ-5D scores and slower gait speed (p = 0.011 and p = 0.002, respectively). In contrast, level of eGFR was not associated with any functional outcome measures when accounting for covariates. Conclusions: In individuals aged ≥75 years, albuminuria and eGFR were associated with impairments in physical performance and self-reported functional status; however, only the association with albuminuria remained after adjusting for relevant demographics and comorbidities. Evaluation of albuminuria may provide an additional tool for identifying older individuals at risk for functional impairment.

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Section: Discussionsupporting

confidence: 91%

Association of Albuminuria and Estimated Glomerular Filtration Rate with Functional Performance Measures in Older Adults with Chronic Kidney Disease

Wolfgram

Garcia²,

Evans³

et al. 2017

Am J Nephrol

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“…Although further studies are warranted to determine the clinical implications of these findings, our data suggest that there is a need for heightened awareness of postural BP behavior in those with diminished kidney function. Assessment of the postural BP response merits further study in the CKD population as a potential means of identifying individuals at higher risk of developing hypotension‐related events such as falls, an important outcome not predicted by kidney function alone …”

Section: Discussionmentioning

confidence: 99%

Graded Association Between Kidney Function and Impaired Orthostatic Blood Pressure Stabilization in Older Adults

Canney

O’Connell

Sexton

et al. 2017

JAHA

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BackgroundImpaired orthostatic blood pressure (BP) stabilization is highly prevalent in older adults and is a predictor of end‐organ injury, falls, and mortality. We sought to characterize the relationship between postural BP responses and the kidney.Methods and ResultsWe performed a cross‐sectional analysis of 4204 participants from The Irish Longitudinal Study on Ageing, a national cohort of community‐dwelling adults aged ≥50 years. Beat‐to‐beat systolic and diastolic BP were measured during a 2‐minute active stand test. The primary predictor was cystatin C estimated glomerular filtration rate (eGFR) categorized as follows (mL/min per 1.73 m2): ≥90 (reference, n=1414); 75 to 89 (n=1379); 60 to 74 (n=942); 45 to 59 (n=337); <45 (n=132). We examined the association between eGFR categories and (1) sustained orthostatic hypotension, defined as a BP drop exceeding consensus thresholds (systolic BP drop ≥20 mm Hg±diastolic BP drop ≥10 mm Hg) at each 10‐second interval from 60 to 110 seconds inclusive; (2) pattern of BP stabilization, characterized as the difference from baseline in mean systolic BP/diastolic BP at 10‐second intervals. The mean age of subjects was 61.6 years; 47% of subjects were male, and the median eGFR was 82 mL/min per 1.73 m2. After multivariable adjustment, participants with eGFR <60 mL/min per 1.73 m2 were approximately twice as likely to have sustained orthostatic hypotension (P=0.008 for trend across eGFR categories). We observed a graded association between eGFR categories and impaired orthostatic BP stabilization, particularly within the first minute of standing.ConclusionsWe report a novel, graded relationship between diminished eGFR and impaired orthostatic BP stabilization. Mapping the postural BP response merits further study in kidney disease as a potential means of identifying those at risk of hypotension‐related events.

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“…11 Using a previously published algorithm, we defined serious fall injuries as an Emergency Department (ED) or an inpatient claim for fall-related fractures, brain injuries or joint dislocations. 6,12 In the absence of a fall-related code, a serious fall injury was defined as an ED or inpatient claim for any of the above serious injuries without a motor vehicle accident. 6,12,13 For the analysis of serious fall injuries, each participant was followed from their REGARDS in-home study visit to the first occurrence of a serious fall injury, loss of Medicare fee-for-service Parts A or B coverage, initiation of Part C coverage, death or December 31, 2014.…”

Section: Methodsmentioning

confidence: 99%

Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension

et al. 2017

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Antihypertensive medication and low systolic and diastolic blood pressure (SBP and DBP) have been associated with an increased falls risk in some studies. Many older adults have indicators of frailty, which may increase their risk for falls. We contrasted the association of SBP, DBP, number of antihypertensive medication classes taken, and indicators of frailty with risk for serious fall injuries among 5,236 REasons for Geographic and Racial Difference in Stroke study participants ≥65 years taking antihypertensive medication at baseline with Medicare fee-for-service coverage. SBP and DBP were measured and antihypertensive medication classes being taken assessed through a pill bottle review during a study visit. Indicators of frailty included low body mass index, cognitive impairment, depressive symptoms, exhaustion, impaired mobility and history of falls. Serious fall injuries were defined as fall-related fractures, brain injuries or joint dislocations using Medicare claims through December 31, 2014. Over a median of 6.4 years, 802 (15.3%) participants had a serious fall injury. The multivariable-adjusted hazard ratio for a serious fall injury among participants with 1, 2 or ≥3 indicators of frailty versus no frailty indicators were 1.18 (95% confidence interval [CI], 0.99–1.40), 1.49 (95%CI, 1.19–1.87) and 2.04 (95%CI, 1.56–2.67), respectively. SBP, DBP, and number of antihypertensive medication classes being taken at baseline were not associated with risk for serious fall injuries after multivariable adjustment. In conclusion, indicators of frailty, but not BP or number of antihypertensive medication classes, were associated with increased risk for serious fall injuries among older adults taking antihypertensive medication.

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Association of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults

Cited by 45 publications

References 31 publications

Association of Albuminuria and Estimated Glomerular Filtration Rate with Functional Performance Measures in Older Adults with Chronic Kidney Disease

Association of Albuminuria and Estimated Glomerular Filtration Rate with Functional Performance Measures in Older Adults with Chronic Kidney Disease

Graded Association Between Kidney Function and Impaired Orthostatic Blood Pressure Stabilization in Older Adults

Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension

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