Prognostic Signature of Chronic Kidney Disease in Advanced Age: Secondary Analysis from the InGAH Study with One-Year Follow-Up.

Anna Maria Meyer,Maria Cristina Polidori,Malte P Bartram,Ingrid Becker,Lena Pickert,Thomas Benzing,Christine Kurschat,Annika Heeß

doi:10.3390/biom12030423

Abstract

The negative impact of chronic kidney disease (CKD) on health status and quality of life in older patients has been well documented. However, data on frailty trajectories and long-term outcomes of older CKD patients undergoing structured Comprehensive Geriatric Assessment (CGA) with multidimensional frailty evaluation are sparse. Here, we analysed records from 375 CKD patients admitted to our university hospital (mean age 77.5 (SD 6.1) years, 36% female) who had undergone a CGA-based calculation of the frailty score with the multidimensional prognostic index (MPI) as well as follow-up evaluations at 3, 6 and 12 months after discharge. Based on the MPI score at admission, 21% of the patients were frail and 56% were prefrail. MPI values were significantly associated with KDIGO CKD stages (p = 0.003) and rehospitalisation after 6 months (p = 0.027) and mortality at 3, 6 and 12 months (p = 0.001), independent of chronological age. Kidney transplant recipients (KTR) showed a significantly lower frailty compared to patients with renal replacement therapy (RRT, p = 0.028). The association between frailty and mortality after 12 months appeared particularly strong for KTR (mean MPI 0.43 KTR vs. 0.52 RRT, p < 0.001) and for patients with hypoalbuminemia (p < 0.001). Interestingly, RRT was per se not significantly associated with mortality during follow up. However, compared to patients on RRT those with KTR had a significantly lower grade of care (p = 0.031) and lower rehospitalisation rates at 12 months (p = 0.010). The present analysis shows that the large majority of older CKD inpatients are prefrail or frail and that the risk for CKD-related adverse outcomes on the long term can be accurately stratified by CGA-based instruments. Further studies are needed to explore the prognostic and frailty-related signature of laboratory biomarkers in CKD.

Highlights

As life expectancy continues to improve, kidney aging has become an important challenge in clinical practice [1]
Frailty in chronic kidney disease (CKD) patients, which is strongly associated with the KDIGO G-stages
These findings indicate that an multidimensional prognostic index (MPI) assessment should be used in older CKD patients to determine the prognosis

Summary

Introduction

As life expectancy continues to improve, kidney aging has become an important challenge in clinical practice [1]. A decline in total nephron size and number, tubulointerof the changes, latter being associatedbasement to pathologic manifestations andand others being part of the physstitial glomerular membrane thickening increased glomeruloscleiological aging process [4]. Altered haemodynamic, physiologic changes, glomerular basement membrane thickening and increased glomerulosclerosis and transcriptomic behaviour at rest impact on response to renal insults [2]. Altered haemodynamic, physiologic and quence, the ability of the kidney to withstand and recover from injury declines with age transcriptomic behaviour at rest impact on response to renal insults [2]. CKD the ability of the kidney to withstand and recover from injury declines with age and the risk is a complex condition generally arising from a disordered kidney filtration barrier within of developing progressive chronic kidney disease (CKD) increases [4]. CKD is a complex glomeruli and is defined as damage of the glomerular filter (i.e., albuminuria) or decondition generally arising from a disordered kidney filtration barrier within glomeruli creased kidney function (i.e., glomerular filtration rate [GFR]

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Discussion

Conclusion