Prevalence of reduced kidney function and albuminuria in older adults: the Berlin Initiative Study

Ebert, Natalie; Jakob, Olga; Gaedeke, Jens; Giet, Markus van der; Kuhlmann, Martin K.; Martus, Peter; Mielke, Nina; Schuchardt, Mirjam; Tölle, Markus; Wenning, Volker; Schaeffner, Elke

doi:10.1093/ndt/gfw079

Cited by 62 publications

(62 citation statements)

References 28 publications

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“…We found that age, BMI, CAD, non-HDL cholesterol, and female sex were independent predictors of CKD in the BASE-II cohort, which has previously been reported for other CKD cohorts [30,36,37] . However, in addition to those factors, we demonstrated that polypharmacy significantly raised the odds of having CKD.…”

Section: Discussionsupporting

confidence: 85%

Prevalence of Impaired Kidney Function in the German Elderly: Results from the Berlin Aging Study II (BASE-II)

König

Gollasch²,

Demuth³

et al. 2017

Gerontology

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Background: In aging populations with an ever-growing burden of risk factors such as obesity, diabetes, and hypertension, chronic kidney disease (CKD) is on the rise. However, little is known about its exact prevalence among elderly adults, and often albuminuria is not included in the definition of CKD. Moreover, novel equations for the estimated glomerular filtration rate (eGFR) have recently emerged, which have not been applied comprehensively to older adults. Data on CKD awareness among the elderly are sparse. Objectives: To determine the prevalence of CKD among older adults by eGFR and albumin/creatinine ratio (ACR), compare the performance of 6 established and novel eGFR formulas, explore risk factors, and determine the awareness of CKD in a large cohort of community-dwelling elderly from Germany. Methods: A total of 1,628 subjects from the Berlin Aging Study II (BASE-II) were included in this analysis (mean age 68.7 years; 51.2% female). Extensive cross-sectional data on sociodemographics, lifestyle, medication, and diagnoses were inquired during structured interviews and a medical examination, and blood and urine parameters were measured. Results: In all, 77.1% of the subjects had hypertension, 12.4% had diabetes, and 18.3% were obese. The prevalence of CKD strongly depended on the eGFR equations used: 25.4% (full age spectrum [FAS] equation), 24.6% (Berlin Initiative Study), 23.1% (Lund-Malmö revised), 19.3% (Cockcroft-Gault), 16.4% (Chronic Kidney Disease-Epidemiology Collaboration [CKD-EPI]), and 14.7% (Modification of Diet in Renal Disease [MDRD]). Of the subjects with an eGFR_FAS <60 mL/min/1.73 m² and/or an ACR >30 mg/g, only 3.9% were aware of having CKD. Polypharmacy, age, BMI, coronary artery disease, non-HDL cholesterol, and female sex were independently associated with CKD. Conclusions: CKD is prevalent among older adults in Germany, but awareness is low. The FAS equation detects higher rates of CKD than MDRD and CKD-EPI, which are most widely used at present. Also, when CKD is defined based on eGFR and albuminuria, considerably more people are identified than by eGFR alone. Finally, polypharmacy is associated with an increased risk for CKD in the elderly.

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Section: Discussionsupporting

confidence: 85%

Prevalence of Impaired Kidney Function in the German Elderly: Results from the Berlin Aging Study II (BASE-II)

König

Gollasch²,

Demuth³

et al. 2017

Gerontology

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“…Indeed, the average measured GFR for a representative cohort of community-living adults .70 years of age is approximately 60 ml/min per 1.73 m 2 . 42 Therefore, by criteria-based definitions, 50% of persons over age 70 years old might be labeled as having CKD; a substantial number of the elderly likely have only physiologic aging of the kidneys (Figure 1), which is not a disease per se.…”

Section: Prevalence Of Ckd In the Elderlymentioning

confidence: 99%

Structural and Functional Changes in Human Kidneys with Healthy Aging

Hommos

Glassock

Rule

2017

JASN

284

223

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Aging is associated with significant changes in structure and function of the kidney, even in the absence of age-related comorbidities. On the macrostructural level, kidney cortical volume decreases, surface roughness increases, and the number and size of simple renal cysts increase with age. On the microstructural level, the histologic signs of nephrosclerosis (arteriosclerosis/arteriolosclerosis, global glomerulosclerosis, interstitial fibrosis, and tubular atrophy) all increase with age. The decline of nephron number is accompanied by a comparable reduction in measured whole-kidney GFR. However, single-nephron GFR remains relatively constant with healthy aging as does glomerular volume. Only when glomerulosclerosis and arteriosclerosis exceed that expected for age is there an increase in single-nephron GFR. In the absence of albuminuria, age-related reduction in GFR with the corresponding increase in CKD (defined by an eGFR<60 ml/min per 1.73 m) has been shown to associate with a very modest to no increase in age-standardized mortality risk or ESRD. These findings raise the question of whether disease labeling of an age-related decline in GFR is appropriate. These findings also emphasize the need for a different management approach for many elderly individuals considered to have CKD by current criteria.

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“…However, it should be noted that this low response rate can be expected in similar studies with older adults (Murphy, Schwerin, Eyerman, & Kennet, 2008). The BIS population has been shown to be representative of the German general population of older adults with regard to the morbidity structure of the participants of the same age and sex (Busch, Schienkiewitz, Nowossadeck, & Gosswald, 2013; Ebert et al, 2016; Gosswald, Schienkiewitz, Nowossadeck, & Busch, 2013; Jacob, Breuer, & Kostev, 2016; Tamayo, Brinks, Hoyer, Kuß, & Rathmann, 2016). A second limitation is that we were not able to use mortality data, so estimated effects may be partially distorted by the censoring of participants who died.…”

Section: Discussionmentioning

confidence: 99%

“…With focus on our research question, we included the following variables: Smoking (never smoked or stopped smoking >10 years ago, current smoker or stopped ≤10 years ago), alcohol consumption (no regular consumption; moderate consumption: women ≤12 g alcohol/day, men ≤24 g alcohol/day; risky drinking: women >12 g alcohol/day, men >24 g alcohol/day), body mass index (BMI; <25, 25–30, >30), arterial hypertension (intake of antihypertensive medication); history of stroke, myocardial infarction, or cancer (all self‐reported yes/no and validated by physician letters); kidney disease (estimated glomerular filtration rate < 60 ml/min/1.73 m 2 ); and diabetes mellitus (intake of antidiabetic medication and/or HbA1c level > 6.5%, yes/no); see Schaeffner et al (2010) and Ebert et al (2016) for further details.…”

Section: Methodsmentioning

confidence: 99%

Is there an association between social determinants and care dependency risk? A multi‐state model analysis of a longitudinal study

Schneider

Blüher

Grittner

et al. 2020

Research in Nursing & Health

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Despite a growing body of knowledge about the morbidities and functional impairment that frequently lead to care dependency, the role of social determinants is not yet well understood. The purpose of this study was to examine the effect of social determinants on care dependency onset and progression. We used data from the Berlin Initiative Study, a prospective, population-based cohort study including 2,069 older participants living in Berlin. Care dependency was defined as requiring substantial assistance in at least two activities of daily living for 90 min daily (level 1) or 3+ hours daily (level 2). Multi-state time to event regression modeling was used to estimate the effects of social determinants (partnership status, education, income, and sex), morbidities, and health behaviors, characteristics, and conditions. During the study period, 556 participants (27.5%) changed their status of care dependency. Participants without a partner at baseline were at a higher risk to become care-dependent than participants with a partner (hazard ratio [HR], 95% confidence interval [CI]: 1.24 (1.02-1.51)). After adjustment for other social determinants, morbidities and health behaviors, characteristics, and conditions the risk decreased to a HR of 1.19 (95% CI: 0.79-1.79). Results indicate that older people without a partner may tend to be at higher risk of care dependency onset but not at higher risk of care dependency progression.Clinicians should inquire about and consider patients' partnership status as they evaluate care needs. K E Y W O R D S activities of daily living, care dependency, cohort studies, marital status, proportional hazards models, social determinants of health --This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. contributed equally to this study. d Kidney disease: eGFR <60 ml/min/1.73 m 2 (GFR estimated by the CKD-EPI(crea) equation). 234 | SCHNEIDER ET AL.

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Prevalence of reduced kidney function and albuminuria in older adults: the Berlin Initiative Study

Abstract: The BIS is a very well-characterized, representative cohort of older adults. Participants with an ACR ≥30 had significantly higher odds for most cardiovascular risk factors compared with an ACR <30 mg/g. Kidney function declined and ACR rose with increasing age.

Cited by 62 publications

References 28 publications

Prevalence of Impaired Kidney Function in the German Elderly: Results from the Berlin Aging Study II (BASE-II)

Prevalence of Impaired Kidney Function in the German Elderly: Results from the Berlin Aging Study II (BASE-II)

Structural and Functional Changes in Human Kidneys with Healthy Aging

Is there an association between social determinants and care dependency risk? A multi‐state model analysis of a longitudinal study

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