Moderately Reduced Estimated Glomerular Filtration Rate (eGFR) among Community - Dwelling Older People Associated with Increased Long Term Mortality: A Study from Low to Middle Income Country in Asia.

Abstract

Background: Reduced glomerular filtration rate (GFR) is regarded as a component of renal senescence; however, the full impact of chronic kidney disease (CKD) among older people is still not fully understood. This study aimed to investigate the effect of reduced GFR on all-cause mortality, and the combined effect of socioeconomic status and CKD on mortality among older Thai population.Methods: A retrospective cohort of Thai population aged >60 years was enrolled from the Fourth National Health Examination Survey, and estimated GFR (eGFR) and comorbid disease data were collected. Mortality information was gathered from the National Civil Registration and Vital Statistics System. Factors associated with all-cause mortality were determined using Cox proportional hazards model.Results: A total of 9,080 participants (mean age: 69.5 years) were included. Prevalence of CKD stage 3-5 was 53.3%. During the 2008-2015 period, the overall mortality rate among CKD was 28.9 per 1,000 person-years. The stages of CKD significantly associated with increased mortality were stages 3b, 4, and 5, as follows: HR: 1.44 (95% CI: 1.24-1.67), 2.42 (95% CI: 1.98-2.96), and HR: 6.43 (95% CI: 4.67-8.87), respectively. People with higher socioeconomic status and moderate-stage CKD had lower mortality than lower socioeconomic status moderate-stage CKD.Conclusion: Moderate decline in eGFR was found to be independently associated with all-cause mortality in Thai elderly population. Socioeconomic disparities were also observed among older CKD. Implementation of a mass screening program to identify asymptomatic individuals would accelerate diagnosis and treatment, and this would reduce the costs of care associated with advanced-stage disease.