Age affects outcomes in chronic kidney disease

Area of Science:

• Nephrology
• Geriatrics
• Epidemiology

Background:

• Chronic kidney disease (CKD) is prevalent in the elderly, yet age-specific clinical outcomes remain unclear.
• Understanding how age influences CKD progression and mortality is crucial for effective patient management.

Purpose of the Study:

• To investigate age-specific incidence of death, end-stage renal disease (ESRD), and estimated glomerular filtration rate (eGFR) decline in CKD patients.
• To determine how age modifies the relationship between eGFR and clinical outcomes in CKD.

Main Methods:

• Analysis of a large cohort (209,622) of US veterans with CKD stages 3-5.
• Longitudinal follow-up (mean 3.2 years) assessing age-specific rates of death, ESRD, and eGFR changes.
• Stratification by age groups to compare outcomes at comparable eGFR levels.

Main Results:

• Older patients (≥75 years) constituted 47% of the cohort and 28% of ESRD cases.
• While lower eGFR correlated with higher death and ESRD rates across all ages, older patients had higher mortality and lower ESRD rates at similar eGFR levels.
• The eGFR threshold where ESRD risk exceeded death risk varied significantly by age, being lower in older individuals.
• Patients aged ≥85 years consistently showed higher death than ESRD risk.
• Older patients with eGFR <45 ml/min/1.73 m² experienced slower annual eGFR decline compared to younger counterparts.

Conclusions:

• Age is a critical factor modifying clinical outcomes in CKD, particularly with eGFR <60 ml/min/1.73 m².
• Current uniform, stage-based CKD management may not be optimal for all age groups.
• Clinical decision-making for CKD should incorporate age-specific risk-benefit analyses for interventions like dialysis.