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Comparison of chronic kidney disease progression and associated complications between geriatric and non-geriatric
Sibel Gulcicek1, Nurhan Seyahi2
1Department of Nephrology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Insights
Geriatric patients with chronic kidney disease (CKD) show slower progression and fewer complications than non-geriatric patients. This suggests physiological aging, not just kidney disease, contributes to GFR decline in older adults.
Area of Science:
- Nephrology
- Geriatrics
- Internal Medicine
Background:
- The physiologic decline in estimated glomerular filtration rate (GFR) in geriatric patients with chronic kidney disease (CKD) is not well understood.
- There is a lack of consensus on whether aging or CKD itself is primarily responsible for GFR decline in older adults.
Purpose of the Study:
- To compare the progression of CKD and associated complications between geriatric and non-geriatric patients.
- To investigate the impact of physiological aging on CKD progression.
Main Methods:
- Retrospective data collection from 506 patients aged 30-90 with CKD stage 2 or higher.
- Comparison of CKD progression, laboratory findings, and complication rates between geriatric (>65 years) and non-geriatric individuals.
Main Results:
- Geriatric patients exhibited a smaller change in eGFR over time and a lower rate of progressive renal disease compared to non-geriatric patients.
- Prevalence of hyperkalemia, hyperparathyroidism, and acidosis was lower in geriatric patients across various CKD stages.
- Hypertension was more prevalent in geriatric patients, but PTH and HCO3 levels differed significantly.
Conclusions:
- CKD progression and secondary complications are less prevalent in geriatric patients, suggesting physiological aging plays a role in GFR decline.
- The findings support the need for age-related definitions in CKD to better understand GFR changes in older adults.
Abstract:
There is no consensus on the physiologic decline in estimated glomerular filtration rate (GFR) due to geriatric conditions related with the aging or chronic kidney disease (CKD) itself. In this study, we aimed to compare the CKD progression and associated complications in a large sample of geriatric and non-geriatric patients. The data of in 506 patients at age between 30 to 90 years and diagnosed with CKD at stage 2 and above (15 mL/min/1.73 m2 ≤ eGFR < 90 mL/min/1.73 m2) were collected retrospectively and compared among geriatric (>65 years old) and non-geriatric individuals. The rate of hypertension was higher in geriatrics compared to non-geriatrics (96.6% vs 91.9%, P = .04). Among laboratory findings, only PTH level was significantly lower and HCO3 concentration was higher in geriatrics compared to non-geriatrics (P = .02, P < .001, respectively). There was no significant difference in last measured eGFR (P = .99) while that measured 4 years ago was lower in geriatrics compared to that of non-geriatrics (P < .001). eGFR change was smaller in geriatrics compared to non-geriatrics (P < .001), and rate of progressive renal disease among non-geriatric group (39%) was found to be significantly higher than in the geriatrics (17.2%) (P < .001). The prevalence of hyperkalemia was lower in geriatrics at stage 3a (P = .02); prevalence of hyperparathyroidism was lower in those at stage 3b (P = .02) and lastly the acidosis was observed significantly lower in geriatric patients at stage 3a, 3b, and 4 compared to the non-geriatrics at corresponding stages (P < .001, P = .03, and P = .04, respectively). The eGFR change was significantly smaller in geriatrics at stage 3b and 4 (P < .001 and P = .04, respectively) while the rate of progressed renal disease was lower in geriatrics at stage 3a and 3b (21.1% vs 9.9%, P = .03 and 41.2% vs 11.1%, P < .001, respectively). eGFR change in 4-year period and the rates of progressive renal disease are higher in the non-geriatrics and also the prevalence of secondary complications of CKD, such as hyperparathyroidism, acidosis, and hyperkalemia, are higher in non-geriatrics. This may reflect that decline of GFR in geriatric individuals is at least partially related to physiological aging rather than kidney disease. Therefore, devising age related CKD definitions might be appropriate.
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