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Outcomes for older people with screening-detected versus existing chronic kidney disease: a cohort study with data
Anna K Forbes1, José M Ordóñez-Mena1,2, Winnie Mei1
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Insights
Screening older adults for chronic kidney disease (CKD) shows comparable risks for mortality, hospitalization, and cardiovascular disease (CVD) compared to routine diagnosis. This suggests screening may be valuable for early detection in this population.
Area of Science:
- Nephrology
- Public Health
- Geriatrics
Background:
- Chronic kidney disease (CKD) affects a significant portion of older adults globally, increasing risks for cardiovascular disease (CVD), end-stage kidney disease (ESKD), and mortality.
- Many cases of CKD in the elderly remain undiagnosed, highlighting a gap in understanding the benefits of screening.
- Existing research provides limited insight into the value of CKD screening in older populations.
Purpose of the Study:
- To compare adverse health outcomes between individuals with pre-existing CKD diagnoses and those identified through screening.
- To identify key factors associated with mortality in patients diagnosed with CKD.
Main Methods:
- A prospective cohort study involving 892 primary care patients aged 60 years and older with CKD (either existing or screening-detected).
- Data linkage with civil death registries and secondary care records was utilized.
- Cox proportional hazard models were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for various outcomes.
Main Results:
- Over a median follow-up of 3-5 years, no significant difference in composite adverse outcomes was observed between existing CKD and screening-detected CKD groups (HR 0.94, 95% CI = 0.67 to 1.33).
- Factors associated with increased mortality risk included older age (HR 1.10), male sex (HR 2.31), and heart failure (HR 5.18).
- Key outcomes recorded included all-cause mortality (49 deaths), hospitalizations (512), and incident CVD events (78).
Conclusions:
- Screening older adults for CKD appears valuable, as identified individuals face risks of mortality, hospitalization, and CVD comparable to those routinely diagnosed.
- Further large-scale studies with extended follow-up are necessary.
- Research should focus on diverse and representative older adult populations to confirm these findings.
Background:
Chronic kidney disease (CKD) is a common health problem associated with increased risk of cardiovascular disease (CVD), end-stage kidney disease (ESKD), and premature death. It is estimated that one-third of people aged ≥70 years have CKD globally, many of whom are undiagnosed, but little is known about the value of screening.
Aim:
To compare the risk of adverse health outcomes between people with an existing diagnosis of CKD and those identified through screening, and identify factors associated with mortality in CKD.
Design & Setting:
Prospective cohort study of 892 primary care patients aged ≥60 years with CKD (existing and screening detected) in Oxfordshire, with data linkage to civil death registry and secondary care.
Method:
Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models to compare the risk of all-cause mortality, hospitalisation, CVD, ESKD separately, and as a composite between CKD groups, as well as to identify factors associated with mortality.
Results:
After a median follow-up of 3-5 years, 49 people died, 512 were hospitalised, 78 had an incident CVD event, and none had an ESKD event. There was no difference in the composite outcome between those with existing CKD and those identified through screening (HR 0.94, 95% CI = 0.67 to 1.33). Older age (HR 1.10, 95% CI = 1.06 to 1.15), male sex (HR 2.31, 95% CI = 1.26 to 4.24), and heart failure (HR 5.18, 95% CI = 2.45 to 10.97) were associated with increased risk of death.
Conclusion:
Screening older people for CKD may be of value, as their risk of short-term mortality, hospitalisation, and CVD is comparable with people routinely diagnosed. Larger studies with longer follow-up in more diverse and representative populations of older adults are needed to corroborate these findings.
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