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Chronic kidney disease in octogenarians
Shani Shastri1, Hocine Tighiouart, Ronit Katz
1Tufts Medical Center, Boston, MA 02111, USA.
Insights
Chronic kidney disease (CKD) is highly prevalent in octogenarians, with varying prevalence based on the estimating equation used. CKD showed a significant association with cardiovascular disease (CVD) in this elderly population.
Area of Science:
- Nephrology
- Geriatrics
- Cardiology
Background:
- Limited data exist on chronic kidney disease (CKD) prevalence and clinical significance in the very elderly.
- Octogenarians represent a unique demographic for studying age-related health conditions.
Purpose of the Study:
- To determine the prevalence of CKD in octogenarians.
- To investigate the association between prevalent CKD and cardiovascular disease (CVD) in this age group.
Main Methods:
- Cross-sectional analysis of 1028 participants from the Cardiovascular Health Study All Stars.
- CKD defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m(2).
- GFR estimated using CKD-Epi creatinine and cystatin C equations (eGFR(EPI), eGFR(CYS3var), eGFR(CYS1var)).
- Prevalent CVD defined as a composite of coronary heart disease, heart failure, and stroke.
Main Results:
- Mean age was 86 years; 39% had prevalent CVD.
- CKD prevalence varied by equation: 51% (eGFR(EPI)), 46% (eGFR(CYS3var)), and 33% (eGFR(CYS1var)).
- CKD was associated with CVD, with odds ratios ranging from 1.53 to 2.09 depending on the equation used.
Conclusions:
- Reduced eGFR is highly prevalent in octogenarians.
- The eGFR(CYS1var) equation showed the strongest association between CKD and CVD, despite the lowest CKD prevalence.
- Estimates of kidney function in the elderly should be interpreted cautiously due to the lack of validated equations.
Background And Objectives:
There are limited data on the prevalence of chronic kidney disease (CKD) and its clinical importance in the very old. We examined the prevalence of CKD in octogenarians and its association with cardiovascular disease (CVD).
Design, Setting, Participants, & Measurements:
In a cross-sectional analysis of 1028 participants from the Cardiovascular Health Study All Stars, we evaluated association of prevalent CKD with CVD using multivariable logistic regression. CKD was defined as eGFR of <60 ml/min per 1.73 m(2). GFR was estimated using CKD-Epi creatinine and cystatin C equations that incorporate coefficients for age, gender, and race (eGFR(EPI), eGFR(CYS3var)) and the one-variable cystatin C equation (eGFR(CYS1var)). Prevalent CVD was defined as a composite of coronary heart disease, heart failure, and stroke.
Results:
Mean age was 86 years, 64% were women, 86% were Caucasians, 14% had diabetes, and 39% had prevalent CVD. Mean eGFR(EPI), eGFR(CYS3var), and eGFR(CYS1var) were 59, 62, and 70 ml/min per 1.73 m(2), and 51%, 46%, and 33% had CKD, respectively. Associations of CKD with CVD varied by equation in adjusted analyses: CKD(EPI) (OR, 1.53; 95% CI, 1.15 to 2.03), CKD(CYS3var) (OR, 1.67; 95% CI, 1.25, 2.23), and CKD(CYS1var) (OR, 2.09; 95% CI, 1.55, 2.83).
Conclusions:
Reduced eGFR is highly prevalent in octogenarians, and the eGFR(CYS1var) equation yielded the lowest prevalence of CKD but the strongest association with prevalent CVD. Because there are no validated estimating equations in the elderly, estimation of kidney function on the basis of on any one equation should be interpreted with caution.
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