AGNES-AGing NEphropathy study-a prospective cohort of older patients with advanced chronic kidney disease

In older patients with chronic kidney disease (CKD), comorbidities, functional status, nutritional patterns and sleep disorders should be considered in the individualised shared decision-making process to initiate dialysis. We conducted a prospective cohort study to assess independent factors related to dialysis initiation or death.

Single centre observational study that included patients ≥70 years with stage 4-5 CKD undergoing conservative management. We evaluated sleep disorders, nutritional markers, and bone biomarkers.

In total, 150 patients (81 ± 7 years, Charlson score 7.8 ± 1.6, followed for a median of 1.8 years). At 2 years, 90 patients (60%) were alive and not on dialysis, 25 (16.7%) started dialysis, and 35 (23.3%) died. In a multivariable multinomial regression model, higher creatinine [OR 2.38 (1.49-3.80), P = .001] and excessive daytime sleepiness [OR 7.47 (1.86-30.00), P = .018] increased the likelihood of dialysis, while higher Charlson comorbidity scores [OR 1.49 (1.08-2.05), P = .049] and beta-blocker use [OR 4.93 (1.58-15.39), P = .019] increased the risk of death. Patients using angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI-ARB) had a lower probability of requiring dialysis (P = .005) and a lower probability of death (P = .005).

In older patients with advanced CKD, comorbidity burden and beta-blocker use were associated with an increased risk of death, whereas ACEI/ARB use was linked to a lower likelihood of both dialysis initiation and death. These findings highlight the importance of a comprehensive, multidimensional approach that integrates clinical, functional, and therapeutic factors to better inform individualised care and enhance outcomes in this population.