Progression of kidney dysfunction in the community-dwelling elderly.

Area of Science:

• Nephrology
• Geriatrics
• Epidemiology

Background:

• Chronic kidney disease (CKD) is common in older adults.
• Limited data exists on kidney function decline in this demographic.
• Understanding CKD progression is crucial for geriatric care.

Purpose of the Study:

• To assess the rate of kidney dysfunction progression in a large community-based cohort of elderly subjects.
• To identify factors associated with kidney function decline in older individuals.
• To provide insights into the natural history of CKD in the elderly population.

Main Methods:

• A cohort of 10,184 subjects aged 66+ years was analyzed.
• Serum creatinine measurements from 2001-2003 were used to calculate estimated glomerular filtration rate (eGFR).
• A mixed effects model analyzed eGFR decline per year, adjusting for age, gender, diabetes, and comorbidity.

Main Results:

• The majority of elderly subjects experienced no or minimal eGFR decline over a median follow-up of 2.0 years.
• Subjects with diabetes mellitus showed the fastest eGFR decline (2.1 ml/min/1.73 m²/year in women, 2.7 ml/min/1.73 m²/year in men).
• Individuals with a mean eGFR < 30 ml/min/1.73 m² experienced the most significant decline, irrespective of diabetes status.

Conclusions:

• Most elderly individuals exhibit stable kidney function over a 2-year period.
• Diabetes mellitus and severely reduced kidney function are key risk factors for accelerated CKD progression in the elderly.
• Future strategies to slow CKD progression should account for these risk factors while acknowledging the general stability observed in the majority of older adults.