Investigating the Relationship Between Age and Kidney Failure in Adults With Category 4 Chronic Kidney Disease

Abstract

Background: In people with severe chronic kidney disease (CKD), there is an inverse relationship between age and kidney failure. If this relationship is the same at any age (linear), one effect (hazard ratio) will be sufficient for accurate risk prediction; if it is nonlinear, the effect will vary with age. Objective: To investigate the relationship between age and kidney failure in adults with category G4 chronic kidney disease (G4 CKD). Methods: We performed a population-based study using linked administrative databases in Alberta, Canada, to study adults with G4 CKD (estimated glomerular filtration rate [eGFR] = 15-30 mL/min/1.73 m2) and without previously documented eGFR <15 mL/min/1.73 m2 or renal replacement. We used cause-specific Cox regression to model the relationship between age and the hazard of kidney failure (the earlier of eGFR <10 mL/min/1.73 m2 or receipt of renal replacement) and death, incorporating spline terms to capture any nonlinear effect of age. We included sex, diabetes mellitus, cardiovascular disease, albuminuria, and eGFR in all models. Results: Of the 27 823 participants (97 731 patient-years at risk; mean age = 76 years, ±13), 19% developed kidney failure and 51% died. The decline in the hazard of kidney failure associated with a given increase in age was not constant but became progressively larger as people aged; that is, the hazard ratio became progressively smaller (closer to 0). Assuming an eGFR of 25 mL/min/1.73 m2, for every 10-year increase in age, the hazard ratio declined from 0.76 (95% confidence interval = 0.73-0.79) at age 50 years to 0.43 (95% confidence interval = 34-56) at age 80 years in people without cardiovascular disease, and from 0.75 (95% confidence interval = 0.70-0.79) at age 50 years to 0.36 (95% confidence interval = 0.29-0.45) at age 80 years in people with cardiovascular disease. Conclusions: The relationship between kidney failure and age varies with age. An age-dependent effect, rather than a constant effect, needs to be specified to accurately predict risk. These findings have implications for risk prediction and advanced care planning.

Factors Associated with Chronic Kidney Insufficiency Stage: A Cross-Sectional Study

“…Age is one of the non-modifiable factors that play a role in the progression of CKI, especially in old age. 18 The study results are in line with previous studies that more CKD incidence is in elderly than younger people. 19,20 Decreased estimated glomerular filtration rate (eGFR) in older people is one of the risk factors for high CKI cases at that age.…”

Accounting for the Competing Risk of Death to Predict Kidney Failure in Adults With Stage 4 Chronic Kidney Disease

“…We developed and validated 2 models to predict kidney failure in adults with G4-CKD accounting for the competing risk of death. The risk of kidney failure varies in adults with severe CKD depending on age, sex, index eGFR, degree of albuminuria, and comorbidities . The 2 competing risk models we built with these predictors demonstrated excellent accuracy (defined as well-calibrated models with C index 0.8-0.9) for the entire risk range and prediction time.…”

“…The risk of kidney failure varies in adults with severe CKD depending on age, sex, index eGFR, degree of albuminuria, 3,4 and comorbidities. 5,31 The 2 competing risk models we built with these predictors demonstrated excellent accuracy (defined as well-calibrated models with C index 0.8-0.9) for the entire risk range and prediction time. The standard Cox regression, which does not account for the competing risk of death, provided similar performance during the first 2 years after onset of G4-CKD, but differences began to emerge thereafter, especially among people older than 65 years or with more comorbidities.…”

Pattern of Eosinophil and Neutrophil/ Lymphocyte Ratio in Different Stages of Chronic Kidney Disease.

“…21 Wahsh HA showed that eGFR decreased with advancing age. 22 is research shows that smoking was associated with less severe CKD which contradicts with the previous researches which are stated following. A research conducted by Yacoub R et al showed that smoking was associated with progression of CKD.…”