10-Year Renal Function Trajectories in Community-Dwelling Older Adults: Exploring the Risk Factors for Different Patterns.

Chia-Ter Chao,Chung-Jen Yen,Yung-Ming Chen,Jen-Hau Chen,Kun-Pei Lin,Fu-Hui Ho

doi:10.3390/jcm7100373

Chia-Ter Chao, Chung-Jen Yen + Show 4 more

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https://doi.org/10.3390/jcm7100373

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Abstract

Longitudinal changes of renal function help inform patients’ clinical courses and improve risk stratification. Rare studies address risk factors predicting changes in estimated glomerular filtration rate (eGFR) over time in older adults, particularly of Chinese ethnicity. We identified prospectively enrolled community-dwelling older adults (≥65 years) receiving annual health examinations between 2005 and 2015 with serum creatinine available continuously in a single institute, and used linear regression to derive individual’s annual eGFR changes, followed by multivariate logistic regression analyses to identify features associated with different eGFR change patterns. Among 500 elderly (71.3 ± 4.2 years), their mean annual eGFR changes were 0.84 ± 1.67 mL/min/1.73 m2/year, with 136 (27.2%) and 238 (47.6%) classified as having downward (annual eGFR change <0 mL/min/1.73 m2/year) and upward eGFR (≥1 mL/min/1.73 m2/year) trajectories, respectively. Multivariate logistic regression showed that higher age (odds ratio (OR) 1.08), worse renal function (OR 13.2), and more severe proteinuria (OR 9.86) or hematuria (OR 3.39) were predictive of a declining eGFR while greater waist circumference (OR 1.06) and higher leukocyte counts (OR 1.21) were predictive of an uprising 10-year eGFR. These findings elucidate important features associated with geriatric renal function variations, which are expected to improve their renal care.

Highlights

Chronic kidney disease (CKD) has emerged as an important non-communicable disease worldwide, increasing the risk of adverse health outcomes including cardiovascular events and overall mortality [1]
The estimated glomerular filtration rate (eGFR) increase, and the eGFR decrease groups, we found that higher age, poorer baseline renal function, hyperglycemia, urinalysis abnormalities, including proteinuria and hematuria, were important risk features associated with biochemical eGFR decrease, while lower age, body mass index (BMI), higher waist circumference, and leukocyte counts were factors associated with biochemical eGFR increase
We showed that lower BMI and higher waist circumference were associated with a higher probability of biochemical eGFR increase in these older adults (Table 3); lower BMI might be a surrogate for lower lean body mass while increasing waist circumference could indirectly suggest obesity [36]

Summary

Introduction

Chronic kidney disease (CKD) has emerged as an important non-communicable disease worldwide, increasing the risk of adverse health outcomes including cardiovascular events and overall mortality [1]. Factors that assist in predicting poor renal outcomes in the elderly have been controversial with poor consistency between studies These issues pose a significant challenge to geriatricians and clinicians that provide care for the elderly. Reports from the CKD Prognosis Consortium disclosed that information gleaned from eGFR trajectories could help predict the risk of adverse renal outcomes, independent of the baseline eGFR [9]. There have been few studies addressing risk features associated with eGFR trajectories among relatively healthy older adults, especially those with limited predictors for renal outcome. Studies are urgently needed to identify factors that predict changes in eGFR over time in relatively healthy older adults [12], as are risk factor profiles that likely differ between individuals of diverse ethnicities [13]

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