Diabetic kidney disease in the elderly: prevalence and clinical correlates

Abstract

BackgroundDiabetic kidney disease (DKD) is a major burden in elderly patients with type 2 diabetes (T2DM). Low estimated glomerular filtration rate (eGFR+, < 60 mL/min/1.73 m2) and albuminuria (Alb+) are essential for the diagnosis of DKD, but their association with clinical variables and quality of care may be influenced by ageing.MethodsHere we investigated the association of clinical variables and quality of care measures with eGFR+ and Alb+ in 157,595 T2DM individuals participating to the Italian Association of Clinical Diabetologists (AMD) Annals Initiative, stratified by age.ResultsThe prevalence of eGFR+ and Alb+ increased with ageing, although this increment was more pronounced for low eGFR. Irrespective of age, both the eGFR+ and Alb + groups had the worst risk factors profile when compared to subjects without renal disease, showing a higher prevalence of out-of target values of HbA1c, BMI, triglycerides, HDL-C, blood pressure and more complex cardiovascular (CVD) and anti-diabetic therapies, including a larger use of insulinIn all age groups, these associations differed according to the specific renal outcome examined: male sex and smoking were positively associated with Alb+ and negatively with eGFR+; age and anti-hypertensive therapies were more strongly associated with eGFR+, glucose control with Alb+, whereas BMI, and lipid-related variables with both abnormalities. All these associations were attenuated in the older (> 75 years) as compared to the younger groups (< 65 years; 65–75 years), and they were confirmed by multivariate analysis. Notably, Q-score values < 15, indicating a low quality of care, were strongly associated with Alb+ (OR 8.54; P < 0.001), but not with eGFR+.ConclusionsIn T2DM patients, the prevalence of both eGFR and Albuminuria increase with age. DKD is associated with poor cardiovascular risk profile and a lower quality of care, although these associations are influenced by the type of renal abnormality and by ageing. These data indicate that clinical surveillance of DKD should not be unerestimated in old T2DM patients.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0732-4) contains supplementary material, which is available to authorized users.

Prevalence and Risk Factors of Chronic Kidney Disease among Type 2 Diabetes Patients: A Cross-Sectional Study in Primary Care Practice

“…Our findings showed that T2DM patients aged 56-65, 66-75, and>75 years had more than 2.8-fold, 5.4-fold, and 27.4-fold higher adjusted ORs for CKD, respectively. This result reaffirms that of previous studies that older age was associated with a higher risk of CKD among T2DM patients 33,37,[39][40][41][42]44 . Cardiovascular disease, obesity, and multimorbidity via endothelial cell dysfunction and sympathetic nervous system activation resulting in increased atherosclerosis, hypertension, and progressive nephrosclerosis are believed to explain the mechanisms underlying older age and the risk of CKD 49,50 .…”

“…According to the Global Burden Disease-CKD study, CKD due to diabetes accounted for 30.7% of CKD populations, in which T2DM was the only cause of CKD to illustration a substantial increase in the age-standardised rate (changed by 9.5% from 1990 to 2017) 32 . Globally, the overall prevalence of CKD among T2DM patients varied at 6.0-39.3% (our result found at 24.4%) 17,25,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] . These discrepancies across different settings may be attributed to the variations in diagnostic methods used and ethnicities such as the black race, which is associated with a greater rate of GFR decline 48 .…”

“…Indeed, albuminuria and diabetic retinopathy are components of diabetes-related microvascular complications, especially in those with poor glycaemic control. These factors have been previously recognised as risk factors for the development of CKD in T2DM patients 18,37,39,41,42 . In concordance with previous reports 42,51 , our study demonstrates that anaemia, defined as haemoglobin <12 g/dL in females or <13 g/dL in males, commonly occurs in T2DM patients (38.5%), particularly in the elderly and those with more comorbid conditions.…”

Contribution of Hypertension to Chronic Kidney Disease

“…[4] Moreover, these older patients often have concomitant diabetes mellitus contributing to cardiovascular diseases, and etiology of ESKD is multifactorial. [8] Hypertension is cited as the third most common etiology of ESKD locally, after diabetes mellitus and glomerulonephritis. [9] Regardless of adjudication bias in kidney disease causation, the connection between blood pressure control and the risk of worsening nephropathy has been demonstrated in multiple studies.…”

Estudo da prevalência de competições terapêuticas entre idosos com multimorbidades do estudo SABE (Saúde, Bem-estar e Envelhecimento)

“…[203][204][205] Em idosos com diabetes a prevalência de insuficiência renal pode chegar a aproximadamente 50%. 206,207 Com isso, GPCs tem recomendado o uso com cautela destes AINEs em indivíduos com diabetes. 197,198 Entre as CT mais observadas na população estudada, há, ainda, a combinação de doença pulmonar (doença índice), osteoporose (doença que compete) e corticosteroide (medicamento que compete).…”