Relation between Cardiometabolic Risk Factors and Renal Function among Elderly Population

Individuals with Chronic Kidney Disease (CKD) remain asymptomatic during the early stages and are often diagnosed during advanced stages that require substitution therapy. Older adult population commonly reports a clinical history of cardiometabolic risk factors (i.e., male sex, proteinuria >1 g/day, diabetes, over-weight, obesity, hypertension and dyslipidemia) before the diagnosis of CKD. Early detection of cardiometabolic risk factors can thus act as a screening tool for early detection in reduction in renal function leading to CKD. Present study aims to identify the relation between cardiometabolic risk factors and renal function among elderly population. This was a cross sectional study conducted at National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, from January 2020 to December 2020, on 145 elderly subjects (≥60 years). Data were collected through face-to-face interview using a semi-structured questionnaire and data collection tools, only after informed written consent was taken from the respondents. Study population underwent detail history taking, physical examination and relevant investigations. CKD was diagnosed using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation having estimated glomerular filtration rate (eGFR) <60ml/min or albuminuria ≥30mg/g. Out of the 145 study subjects, 42.1% were from age group 60-65 years of age. Mean age was 68.1±5.8 years. Study population was predominantly male (52.4%) and 59.3% of the respondents were from rural area. Study population was classified using eGFR and ACR values. According to eGFR, 70.3% of the respondents had eGFR ≥60 mL/min/1.73m² and 29.7% had eGFR <60 mL/min/1.73m². According to Albumin-to-Creatinine Ratio (ACR) value, 60.7% of the respondents had ACR <30 and 39.3% had ACR ≥30. Statistically significant (p<0.05) differences were seen for the waist-hip ratio, BMI, BMI classification, tobacco use, betel nut use, serum creatinine and HDL between the two genders. eGFR measured by CKD-EPI equation showed mean eGFR was 71.21±23.65 ml/min/1.73m². Male had significantly higher mean eGFR compared to female (75.19±22.74 vs. 66.81±24.01 ml/min/1.73m²; p<0.05). Among the study population, 25% male and 15.9% female showed moderate to severe decrease in eGFR (<60 ml/min/1.73m²) by CKD-EPI equation which were statistically significant (p<0.05). Statistically significant (p<0.05) differences were seen for the mean age, waist, waist to hip ratio, BMI, serum creatinine and albumin-creatinine ratio between patients with eGFR < 60 mL/min/1.73m² and patients with eGFR ≥60 mL/min/1.73m². Age, waist circumference and albumin-creatinine ratio were significant predictor of variation of eGFR (eGFR <60 ml/min/1.73m²) in the study population in univariate analysis. Female gender was the strongest risk factor for CKD (adjusted OR: 2.57, 95% CI: 1.12-5.88; p<0.05) in multivariate analysis. The second most important risk factor for variation of eGFR was Age (adjusted OR: 1.11, 95% CI: 1.04-1.19; p<0.05). Cardiometabolic risk factors, such as, age, sex, waist circumference, waist-hip ratio, BMI, serum creatinine, albumin-creatinine ratio and urinary albumin showed significant difference between patients with moderate to severe CKD and patents with normal to mildly decreased renal function among elderly population and can be used to predict CKD among such population.