Loss of Renal Function in the Elderly Italians: A Physiologic or Pathologic Process?

Esposito, Ciro; Torreggiani, Massimo; Arazzi, Marta; Serpieri, Nicoletta; Scaramuzzi, Maria Lucia; Manini, Alessandra; Grosjean, Fabrizio; Esposito, Vittoria; Catucci, Davide; Porta, Edoardo La; Canton, Antonio Dal

doi:10.1093/gerona/gls182

Cited by 20 publications

(14 citation statements)

References 40 publications

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“…Participants in the non-CKD group were younger than those in the CKD group, probably because renal function decreases with aging and is an important factor in the increased prevalence of CKD in the elderly. 27,28 The Hgb level in the non-CKD group was the highest among the 3 CKD groups. This might be because less erythrogenin is secreted by impaired kidneys.…”

Section: Discussionmentioning

confidence: 98%

Association of Left Ventricular Hypertrophy With a Faster Rate of Renal Function Decline in Elderly Patients With Non‐End‐Stage Renal Disease

Shi

Wang

et al. 2015

JAHA

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BackgroundSeveral studies have indicated that chronic kidney disease is independently associated with the presence of left ventricular hypertrophy (LVH). However, little clinical data are currently available regarding the detailed correlation between LVH and renal function in elderly patients with non–end‐stage renal disease.Methods and ResultsA total of 300 in‐ and outpatients (more than 60 years of age, non‐end‐stage renal disease), 251 with LVH and 49 without LVH, seen at Beijing Friendship Hospital from January 2000 to December 2010 were included in this retrospective study. One observation period of 12 months was used to detect rapid kidney function decline. The evaluations of cardiac structure and function were performed via echocardiography. The multivariable logistic analysis showed patients with LVH had a much higher risk of rapid kidney function decline than those without LVH. Additionally, the baseline left ventricular mass index was 140 (125–160) g/m2 in the non–chronic kidney disease group, 152 (130–175) g/m2 in the mild chronic kidney disease group (estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73 m2), and 153 (133–183) g/m2 in the severe chronic kidney disease group (eGFR<60 ml/min/1.73 m2), with a significant difference (P=0.009).ConclusionsOur data demonstrate that a high rate of renal function decline contributes to pathological LVH in non–end‐stage renal disease elderly patients and that LVH is positively associated with renal function decline followed by an increased risk of rapid kidney function decline.

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Section: Discussionmentioning

confidence: 98%

Association of Left Ventricular Hypertrophy With a Faster Rate of Renal Function Decline in Elderly Patients With Non‐End‐Stage Renal Disease

Shi

Wang

et al. 2015

JAHA

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“…The risk associated with stage 3a CKD in older patients is still debated, and the GFR threshold at which the risk of mortality increases might be lower among older patients compared with younger patients . Additionally, older people with eGFR <60 mL/min/1.73 m 2 show a slow progression of CKD . However, current guidelines do not calibrate the definition of CKD for age, and suggest many stage‐specific therapeutic measures…”

Section: Discussionmentioning

confidence: 99%

“…30 Additionally, older people with eGFR <60 mL/min/1.73 m 2 show a slow progression of CKD. 31 However, current guidelines do not calibrate the definition of CKD for age, and suggest many stage-specific therapeutic measures. 4 Misclassification also poses important issues in the management of medications cleared by the kidneys, especially among older patients with multiple chronic diseases treated with polypharmacy regimens.…”

Section: Discussionmentioning

confidence: 99%

Agreement between Chronic Kidney Disease Epidemiological Collaboration and Berlin Initiative Study equations for estimating glomerular filtration rate in older people: The Invecchiare in Chianti (Aging in Chianti Region) study

Corsonello

Pedone

Bandinelli³

et al. 2016

Geriatrics Gerontology Int

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Aim The aim was to investigate to what extent chronic kidney disease (CKD) can be staged interchangeably by Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and by Berlin Initiative Study (BIS) equations, and to verify whether cystatin C can improve concordance between formulas. Methods Our series consisted of 828 community-dwelling individuals aged 65 years or older enrolled in the Invecchiare in Chianti Study (“Aging in the Chianti Region”). Estimated glomerular filtration rate was calculated using the creatinine-based CKD-EPI, creatinine/cystatin C-based CKD-EPI, creatinine-based BIS and creatinine/cystatin C-based BIS equations. Agreement and sources of discrepancy between equations in identifying people with different degrees of kidney dysfunction was investigated by κ statistic and Bland–Altman plots. Results Overall, CKD-EPI values were higher than that obtained with BIS equations, especially for eGFR = 30–60 mL/min/1.73 m2. A total of 191 out of 828 participants were classified in stage 2 by the creatinine-based CKD-EPI and in stage 3a by the creatinine-based BIS equation, whereas 123 participants were classified in stage 2 by creatinine/cystatin C-based CKD-EPI and in stage 3a by the creatinine/cystatin C-based BIS equation. A total of 27 participants were classified in stage 3a by creatinine-based CKD-EPI and in stage 3b by creatinine-based BIS equation, whereas 18 were classified as stage 3a by creatinine/cystatin C-based CKD-EPI and stage 3b by the creatinine/cystatin C-based BIS equation. Conclusions Despite a fair overall concordance, the CKD-EPI and BIS equations cannot be considered interchangeable to assess estimated glomerular filtration rate in older people, and using creatinine/cystatin C-based rather than creatinine-based equations only marginally improves the concordance between CKD-EPI and BIS. Disagreement between equations might significantly impact the applications of stage-specific measures for managing CKD among older people.

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“…In a vast majority of cases renal biopsy is irreplaceable in identifying treatable, reversible lesions, as well as in defining both the activity and chronicity of kidney injury. It has been documented that the percentage of patients with the precise kidney disease recognition decreases with age and most of patients aged ≥55 are labelled as ‘CKD of unknown origin’ or ‘nephroangiosclerosis’ [3]. Many nephrologists no longer consider older age as a contraindication to immunosuppressive treatment, which is in line with the growing number of kidney biopsies performed in elderly patients [4].…”

Section: Introductionmentioning

confidence: 99%

Kidney disease in the elderly: biopsy based data from 14 renal centers in Poland

et al. 2016

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BackgroundLonger life expectancy is associated with an increasing prevalence of kidney disease. Aging itself may cause renal damage, but the spectrum of kidney disorders that affect elderly patients is diverse. Few studies, mostly form US, Asia and West Europe found differences in the prevalence of some types of kidney diseases between elderly and younger patients based on renal biopsy findings, with varied proportion between glomerulopathies and arterionephrosclerosis as a dominant injury found. Here, for the first time in Eastern Europe we analyzed native kidney biopsy findings and their relationship to clinical characteristics at the time of biopsy in elderly individuals (aged ≥65) in comparison to younger adults (aged 18–64).MethodsBiopsy and clinical data from 352 patients aged ≥65 were retrospectively identified, analyzed and compared with a control group of 2214 individuals aged 18–64. All kidney biopsies studied were examined at Medical University of Warsaw in years 2009–14.ResultsIn elderly patients the leading indication for biopsy was nephrotic range proteinuria without hematuria (34.2%) and the most prevalent pathologic diagnoses were: membranous glomerulonephritis (MGN) (18.2%), focal segmental glomerulosclerosis (FSGS) (17.3%) amyloidosis (13.9%) and pauci immune glomerulonephritis (12.8%). Hypertension and age-related lesions very rarely were found an exclusive or dominant finding in a kidney biopsy (1.7%) and a cause of proteinuria (1.1%) in elderly individuals. There were 18.2% diabetics among elderly individuals, and as much as 75% of them had no morphologic signs of diabetic kidney disease in the renal biopsy. Amyloidosis, MGN, pauci immune GN, crescentic GN and light and/or heavy chain deposition disease (LCDD/HCDD) were more frequent whereas IgA nephropathy (IgAN), lupus nephritis (LN) and thin basement membrane disease (TBMD) were less common among elderly than in younger patients.ConclusionsProteinuria, a dominating manifestation in elderly patients subjected to kidney biopsy was most commonly related to glomerulopathies. The relatively high prevalence of potentially curative kidney diseases in elderly individuals implicates the importance of renal biopsy in these patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0410-8) contains supplementary material, which is available to authorized users.

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Loss of Renal Function in the Elderly Italians: A Physiologic or Pathologic Process?

Cited by 20 publications

References 40 publications

Association of Left Ventricular Hypertrophy With a Faster Rate of Renal Function Decline in Elderly Patients With Non‐End‐Stage Renal Disease

Association of Left Ventricular Hypertrophy With a Faster Rate of Renal Function Decline in Elderly Patients With Non‐End‐Stage Renal Disease

Agreement between Chronic Kidney Disease Epidemiological Collaboration and Berlin Initiative Study equations for estimating glomerular filtration rate in older people: The Invecchiare in Chianti (Aging in Chianti Region) study

Kidney disease in the elderly: biopsy based data from 14 renal centers in Poland

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