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Risk factor for progression to kidney failure with replacement therapy in elderly patients with chronic kidney
Hiroshi Nagae1, Yuki Ueno1, Masumi Shojima1
1Kidney Unit, National Hospital Organization, Fukuokahigashi Medical Center, Fukuoka, Japan.
Insights
Elderly patients with chronic kidney disease (CKD) face a high risk of kidney failure with replacement therapy (KFRT). Proteinuria, advanced CKD stage, and other factors significantly increase this risk, necessitating careful monitoring.
Area of Science:
- Nephrology
- Geriatrics
- Epidemiology
Background:
- Increasing prevalence of chronic kidney disease (CKD) in elderly populations.
- Limited understanding of prognosis in elderly CKD patients.
Purpose of the Study:
- To investigate the prognosis of elderly patients with CKD stages G3a-G5.
- To identify independent risk factors for kidney failure with replacement therapy (KFRT) in this demographic.
Main Methods:
- Retrospective cohort study of 301 patients aged ≥75 years with CKD.
- Primary endpoint: KFRT; Secondary endpoints: all-cause mortality and eGFR decline.
- Multivariate Fine-Gray regression analysis for risk factor identification.
Main Results:
- Median follow-up of 24.5 months; 35% developed KFRT, 9% died.
- Kidney survival decreased with advancing CKD stage.
- Independent risk factors for KFRT included younger age, CKD stage G5, proteinuria, hypoalbuminemia, hyperphosphatemia, and hyperuricemia.
Conclusions:
- Elderly CKD patients, especially those with proteinuria, require vigilant monitoring even in early stages.
- Early identification of risk factors is crucial for managing KFRT risk in older adults.
Background:
Although the number of elderly patients with chronic kidney disease (CKD) has increased, few studies have examined their prognosis.
Methods:
The study design was a retrospective cohort study at a single centre. We evaluated 301 patients aged ≥75 years old with CKD stage G3a to G5. The primary endpoint was kidney failure with replacement therapy (KFRT) and secondary endpoints were all-cause mortality and annual decline rates of estimated glomerular filtration rate (eGFR). The incidence of KFRT was estimated using the cumulative incidence method considering the competing risk of death. To identify the independent risk factors related to KFRT, multivariate Fine-Gray regression model analysis were performed.
Results:
The median age of the patients was 79 years and the median eGFR was 24.0 mL/min/1.73 m2 at baseline. Urinary protein was positive in 70% of patients. With a median follow-up of 24.5 months, 35% of the patients developed KFRT and 9% died. Kidney survival significantly decreased according to the CKD stage at baseline. In patients without proteinuria, the cumulative incidence of KFRT increased in CKD stage G5 patients, while in patients with proteinuria, the incidence of KFRT increased from patients with CKD stage G3b. Multivariate Fine-Gray regression model revealed that less aged, CKD stage G5, baseline data such as proteinuria, hypoalbuminemia, hyperphosphatemia, and hyperuricemia were independent risk factors for KFRT.
Conclusion:
Elderly CKD patients with proteinuria need to be carefully monitored even at an early CKD stage because of the risk of developing KFRT.
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