Chronic Kidney Disease In Older Adults Research Articles

U-shaped association between dietary niacin intake and chronic kidney disease among US elderly: a nationwide cross-sectional study.

In addition to hypertension or diabetes, elderly people are also considered one of the high-risk groups for chronic kidney disease (CKD). Although niacin is recognized for its renal protective properties, the link between dietary niacin intake and CKD remains uncertain. This study investigated this relationship in the elderly. We included participants aged 60 and older from the National Health and Nutrition Examination Survey (NHANES) for the years 2003-2018. Dietary niacin intake was assessed through two non-consecutive 24-hour dietary recalls. CKD was diagnosed in individuals with a urine albumin-to-creatinine ratio exceeding 30 mg/g or an estimated glomerular filtration rate below 60 mL/min per 1.73 m^2. The study cohort comprised 4,649 participants, 1,632 of whom had CKD. Propensity score matching (PSM) was utilized to adjust for baseline differences between the groups. Our analysis, using smooth curve fitting and generalized additive models both before and after PSM, found a U-shaped curve depicting the relationship between dietary niacin intake and CKD risk, confirmed by a log-likelihood ratio test (P < 0.05). Threshold effect analysis (after PSM) indicated a reduced risk of CKD in older adults with a niacin intake below 38.83 mg per day [odds ratio (OR)= 0.99, 95% confidence interval (CI) 0.97-1.00]. In contrast, higher intake levels significantly increased the risk (OR = 1.03, 95% CI 1.00-1.06). Subgroup analysis indicated that these associations were consistent across different stratification variables (P for interaction > 0.05). Our findings suggested a U-shaped association between dietary niacin intake and CKD risk among older Americans. However, further prospective cohort studies are needed to confirm this finding.

A Risk Prediction Model for New-Onset Chronic Kidney Disease in the Elderly

Plain Language SummaryDifferent regions have different risk factors for chronic kidney disease (CKD), and using a single model for prediction can often lead to errors. This study aimed to create an easy-to-use tool to predict the risk of CKD in older adults. We analyzed data from 5,416 people aged over 65 who had regular health check-ups between January 2017 and July 2021. We found that about 20% developed CKD during a follow-up period of 2.3 years. Factors like age, being female, diabetes, high triglyceride levels, and initial kidney function were used to build the prediction model. This model was good at forecasting CKD risk and was validated to ensure its accuracy. It can help doctors quickly identify older adults who might be at risk of kidney problems and start early treatment.

A Comprehensive Review of Advanced Biomarkers for Chronic Kidney Disease in Older Adults: Current Insights and Future Directions.

Chronic kidney disease (CKD) is a growing health concern, particularly in older adults, due to its high prevalence and association with increased morbidity and mortality. Early detection and effective management are crucial to slowing disease progression and reducing complications such as cardiovascular events and end-stage renal disease (ESRD). Traditional biomarkers, including serum creatinine and estimated glomerular filtration rate (eGFR), often have limitations in older populations, where age-related physiological changes can obscure early signs of kidney dysfunction. Advanced biomarkers offer a more precise and comprehensive understanding of kidney health, providing insights into pathological processes such as inflammation, fibrosis, oxidative stress, and tubular injury. These biomarkers have the potential to enhance early diagnosis, predict disease progression, and inform personalized treatment approaches, particularly in the elderly. This review explores the current landscape of advanced biomarkers for CKD in older adults, highlighting their clinical utility and limitations. Key biomarkers, including those related to inflammation (C-reactive protein, interleukin-6), fibrosis (transforming growth factor-beta, collagen degradation products), oxidative stress (F2-isoprostanes, malondialdehyde), and tubular injury (kidney injury molecule-1, neutrophil gelatinase-associated lipocalin), are examined in the context of CKD. Emerging technologies, such as multi-omics and machine learning, are also discussed as they offer new opportunities for biomarker discovery and integration into clinical practice. While challenges remain, including the need for longitudinal studies and better standardization, advanced biomarkers hold promise for transforming CKD management in older adults, paving the way for earlier detection, better risk stratification, and more targeted therapeutic interventions.

Fragilidad del adulto mayor con enfermedad renal crónica. Un estudio observacional de centro único

Introduction: Frailty in the elderly (AM) increases morbidity and mortality. This condition is highly prevalent in Chronic Kidney Disease (CKD) and, together with frailty, greatly affects physical, cognitive, and emotional capacity. The study aimed to determine frailty in older adults with CKD in a reference center in Cuenca-Ecuador. Methods: The present observational study was conducted at the “José Carrasco Arteaga” Hospital from September 2020 to April 2021. Older adults with a diagnosis of CKD were included; patients with disabilities, severe cognitive impairment, and those with palliative care were excluded. The direct source variables are demographic, clinical, physical activity, functional capacity, mood, mental state, and frailty. The sample was probabilistic. The Chi2 test is used to compare percentages. Results: 79 cases are analyzed. The MA had 38% frailty, 36.7% were pre-frail, and 25.3% were robust. A more significant proportion of 'young' AM was observed in patients classified as robust. A more substantial proportion of robust patients were receiving clinical treatment, while patients in the hemodialysis program were classified as frail. The most significant proportion of robust patients had mild degrees of renal failure, while frail patients were classified as CKD grades 4 and 5. Physical activity was active primarily in robust patients and mostly passive in patients with frailty. Conclusion: Conclusion: there is a high prevalence of frailty in this population group, especially in women and those between 75 and 85 years old. The results suggest that CKD in older adults is associated with a higher risk of frailty, dependence, and comorbidities, which underlines the importance of implementing multidisciplinary and personalized interventions to improve the quality of life and prognosis of these patients.

#939 Association between alcohol consumption and the risk of incident chronic kidney disease in community-dwelling older adults

Abstract Background and Aims The relationship between alcohol consumption and kidney function decline is not well established, especially in older adults. This study aimed to investigate the effects of alcohol consumption on the risk of incident chronic kidney disease (CKD) in community-dwelling older adults. Method Adults aged ≥ 65 years with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and without proteinuria between 2009 and 2010 were recruited and followed through December 2018 from a Korean national population-based cohort. Alcohol consumption was categorised into non-, mild, moderate, and heavy drinking groups based on self-administered questionnaires. New-onset CKD was defined as an eGFR &amp;lt;60 mL/min/1.73 m2. Results Of the total 122,319 subjects, the non-, mild, moderate, and heavy drinking groups were 99,091 (81.0%), 14,842 (12.1%), 4,257 (3.5%), and 4,139 (3.4%), respectively. During follow-up, 19,796 (20.0%), 4,636 (31.2%), 1,696 (39.8%), and 1,695 (41.0%) developed CKD in the non-, mild, moderate, and heavy drinking groups. Univariate Cox regression analyses showed a significantly increased risk of incident CKD in older adults in all drinking groups compared to non-drinkers (all P &amp;lt; 0.001). However, hazard ratios (HR) for developing CKD were 0.90 (95% confidence interval [CI] 0.87–0.94, P &amp;lt; 0.001) for mild, 0.89 (95% CI 0.84–0.95, P &amp;lt; 0.001) for moderate, and 0.93 (95% CI 0.88–0.99, P = 0.027) for heavy drinkers after fully adjusting for confounding variables. This inverse relationship between alcohol consumption and CKD risk was observed in males in all drinking groups, whereas in females it was found only in mild drinkers. Conclusion In the subgroup analysis, the beneficial effect of alcohol consumption on incident CKD was prominent among moderate drinkers aged 65–75 years, male mild drinkers aged ≥ 75 years, and female mild drinkers aged &amp;lt; 85 years. This study shows that alcohol consumption is inversely associated with the risk of incident CKD in older adults. Further studies are required to elucidate the effects of alcohol on kidney damage in older adults.

Association between dietary diversity and chronic kidney disease in community-dwelling older adults.

The present study examined whether dietary diversity is associated with chronic kidney disease (CKD) in community-dwelling older Japanese adults. Participants comprised 8,195 older adults (mean age was 74.0 ± 5.6years; 42.7% were men) in this cross-sectional study. In this study, CKD was defined as estimated Glomerular Filtration Rate (eGFR) < 45mL/min/1.73m2. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Participants with an FFS of 16 or fewer points were defined as having low dietary diversity. The prevalence of CKD was 376 (4.6%), and the low dietary diversity group had higher prevalence (5.6%) compared with the high and low dietary diversity group (4.3%). Multiple logistic regression analysis revealed low dietary diversity was associated with CKD in older adults (OR 1.30, 95%CI 1.01-1.68). Stratified analysis showed that low dietary diversity was independently associated with CKD (OR 1.43, 95% CI 1.07-1.91) in older adults with hypertension, but not in adults without hypertension (OR 0.94, 95% CI 0.54-1.64). This cross-sectional study revealed that low dietary diversity was associated with CKD among older adults. Furthermore, low dietary diversity was associated with CKD among older adults with hypertension.

Association of mitochondrial DNA copy number with chronic kidney disease in older adults

BackgroundMitochondrial dysfunction in kidney cells has been implicated in the pathogenesis of chronic kidney disease (CKD). Estimation of mitochondrial DNA copy number (mtDNA-CN) is considered a convenient method for representing mitochondrial function in large samples. However, no study has investigated the association between mtDNA-CN and CKD in older adults with the highest prevalence. The objective is to examine cross-sectional and prospective associations between mtDNA-CN values and CKD risk in older adults to determine whether mtDNA-CN represents a novel potential biomarker for the recognition of CKD risk.Patients and methodsIn a Chinese community-based cohort of over 65-year-olds, we included 14,467 participants (52.6% females). CKD was defined by eGFR < 60 mL/min/1.73 m2 or ICD-10 codes (patients = 3831 (26.5%)). Participants had peripheral blood levels of mtDNA-CN calculated from probe intensities of the Axiom CAS Array.ResultsThe risk of CKD prevalence decreased with mtDNA-CN per 1-SD increment, independent of established risk factors for older CKD (odds ratio [OR] per SD 0.90, 95% confidence interval [CI] 0.86, 0.93, P < 0.001), and has comparable strength of association with these established risk factors. Furthermore, the progression of kidney function was stratified according to the worsening of eGFR categories. The risk of kidney function progression to a more severe stage gradually decreased as the mtDNA-CN increased (P trend < 0.001). Non-CKD participants in the highest quartile of mtDNA-CN had a lower risk of developing CKD compared to the lowest quartile within 2 years of follow-up, reducing the risk of CKD by 36% (95% CI 0.42, 0.97; P = 0.037).ConclusionsBased on the analysis of the largest sample to date investigating the association between mtDNA-CN and CKD in older adults, higher levels of mtDNA-CN were found to be associated with a lower risk of CKD, suggesting that a reduced level of mtDNA-CN is a potential risk factor for CKD.

Abstract P536: The Association Between Arterial Stiffness and Incident Chronic Kidney Disease in a Large Community Cohort: The Atherosclerosis in Communities (ARIC) Study

Background: Arterial stiffness was cross-sectionally associated with the prevalence of chronic kidney disease (CKD). Whether arterial stiffness was prospectively associated with incident CKD is not well characterized. Methods: Among 3,777 participants (mean age 75 years old, 42.7% female, 21.3% Blacks) without prevalent CKD in ARIC study at visit 5 (2011 to 2013), we examined the association of six measures for arterial stiffness measurements, carotid-femoral pulse wave velocity (cfPWV), heart-ankle PWV (haPWV), brachial-ankle PWV (baPWV), heart-femoral PWV (hfPWV), femoral-ankle PWV (faPWV), heart-carotid PWV (hcPWV) with the risk of incident CKD (defined by &gt;25% decline to estimated glomerular filtration rate &lt;60 ml/min/1.73m 2 or hospitalization with CKD diagnosis) using Cox regression models to estimate hazard ratios (HRs). Each arterial stiffness parameter was stratified by quartiles. Results: During follow-up (median 6.6 years) through 2019, 590 had incident CKD (incidence rate 23.2 per 1000 person-years). In the demographically adjusted model, the highest quartile (Q4) of cfPWV, haPWV, baPWV, and hfPWV were significantly associated with an increased risk of incident CKD compared to the lowest (Q1) (HR, 1.70 [95%CI 1.31 to 2.22], 1.29 [95% CI 1.01 to 1.64], 1.51 [95% CI 1.16 to 1.97], and 1.36 [95% CI 1.05 to 1.76], respectively). Once the model was further adjusted for major clinical risk factors for CKD, the associations were modestly attenuated but remained significant for cfPWV and haPWV (HR in Q4 vs. Q1, 1.34 [95% CI 1.02 to 1.76] and 1.38 [95% CI 1.04 to 1.82]), but not for baPWV and hfPWV. Subgroup analyses showed the associations were consistent in subgroups by gender, race, age, hypertension, and diabetes. Conclusion: Arterial stiffness as measured by PWV was associated with a higher risk of incident CKD in older adults, especially cfPWV and haPWV. Our findings support the temporal relationship of subclinical arterial stiffness predating incident CKD in older adults.

Abstract 11706: Association of Left Atrial Function With Incident Chronic Kidney Disease: Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Echocardiographic measures of left ventricular (LV) structure and function are associated with incident chronic kidney disease (CKD). Reduced left atrial (LA) function is an emerging novel risk factor for cardiovascular disease but its association with incident CKD is unknown. Hypothesis: Lower LA function is independently associated with incident CKD in older adults in the ARIC study, a prospective community-based cohort. Methods: We included ARIC participants without prevalent CKD (as defined by eGFR&lt;60ml/min/1.73m 2 ) who underwent echocardiographic exam at visit 5 (2011-13). LA function measures included LA reservoir strain, contractile strain, and conduit strain. Incident CKD was defined as a composite outcome of &gt;25% decline to eGFR &lt;60 mL/min/1.73m 2 , hospitalization with CKD diagnosis, or incident end-stage kidney disease through 2017. Cox proportional hazards model was used. Results: Among the 3,970 participants (mean [SD] age, 75 [5] years; 58% women; 20.9% Black individuals), 382 cases of incident CKD were ascertained over a median follow-up of 5.5 years. Lower LA reservoir and contractile strain were significantly associated with higher risk of CKD (HR [95% CI] lowest vs highest quintile: 2.76 [1.91-3.98], and 2.56 [1.79-3.65], respectively) (Table). The associations remained significant after accounting for other major echocardiographic parameters (model 2) including left atrial volume index (model 3). LA conduit strain was not significantly associated with CKD. Conclusions: Lower LA function is significantly associated with incident CKD, independent of CKD risk factors, LV size and function, and LA size. These findings indicate that impaired LA function is a novel predictor marker for CKD.

The associations between urinary metals and metal mixtures and kidney function in Chinese community-dwelling older adults with diabetes mellitus

BackgroundPrevious studies have found associations between single toxic metals, such as arsenic and cadmium, and kidney function in adults with diabetes. However, studies with regards to other metals and metal mixtures are still limited. ObjectiveOur study aimed to investigate the associations between urinary concentrations of 5 selected metals and metal mixtures and kidney function using a sample of older adults with diabetes mellitus in Chinese communities. MethodsIn a sample of older adults (n = 5186), 592 eligible subjects were included in this study. Urinary concentrations of 5 metals, i.e., arsenic (As), cadmium (Cd), vanadium (V), cobalt (Co), and thallium (Tl), were measured by inductively coupled plasma mass spectrometer (ICP-MS). Estimated glomerular filtration rate (eGFR) was calculated and dichotomized into indicator of chronic kidney disease (CKD). Logistic analysis and Bayesian kernel machine regression (BKMR) were used to explore the associations between single metals and metal mixtures and CKD, respectively. ResultsUrinary levels of As and V were positively correlated with CKD (OR=2.37, 95% CI: 1.31–4.30 for As; OR=2.24, 95% CI: 1.25–4.03 for V), when compared the 4th quartile with the 1st quartile. After adjustment for potential confounders, the significant association between As and CKD still existed (OR=2.73, 95% CI: 1.23–6.07). BKMR analyses showed strong linear positive associations between As and V and CKD. Higher urinary levels of the mixture were significantly associated with higher odds of CKD in a dose-response pattern. As and V showed the highest posterior inclusion probabilities. ConclusionUrine As and V were positively associated with CKD in older adults with diabetes mellitus, separately and in a mixture. The metals mixture showed a linear dose-response association with the odds of CKD. The analyses of mixtures, rather than of single metals, may provide a real-world perspective on the relationship between metals and kidney function.

Electrical Activity of the Heart in the Older Adults Suffering from Chronic Kidney Disease: Ethnic and Age Characteristics

The aim of the study was to investigate the ethnic and age-related characteristics of the electrical activity of the heart in older adults with chronic kidney disease (CKD). Methods and Results: A total of 522 patients aged between 60 and 89 years with different stages of CKD were examined. For a comparative analysis, we formed 3 ethnic groups (Yakuts, Evens, and Russians) and 2 age groups (60-74 years and 75-89 years). All patients underwent ECG. The laboratory analysis included determining the blood creatinine level for further calculation of the GFR using the Cockcroft&amp;Gault formula, followed by determining the stage of CKD. A decrease in renal function was more typical for people of 75-89 years. The results of the study confirmed the close relationship of CKD in older adults with the pathology of the cardiovascular system. Changes in the electrical activity of the heart predominated in Russians, compared to other ethnic groups, and were less pronounced in the Evens.

Hypertriglyceridemic waist phenotype and risk of chronic kidney disease in community-dwelling adults aged 60\u2009years and older in Tianjin, China: a 7-year cohort study

BackgroundThe hypertriglyceridemic waist (HTGW) phenotype has been proposed to be related to the occurrence and progression of chronic kidney disease (CKD). The ageing trend of the Chinese population continues to intensify, and elderly individuals are at high risk of CKD. The purpose of this study was to investigate the cross-sectional and longitudinal associations between the HTGW phenotype and the risk of CKD by following community-dwelling adults aged 60 years and older in Tianjin, China, for 7 years.MethodsThis study was an observational cohort study conducted between 2013 and 2019. Of 2050 participants aged 60 years and older who underwent an annual health examination in 2013, 1605 individuals with complete data were enrolled in the cross-sectional analysis. Among them, 1271 individuals were observed until 2019. Detailed follow-up records were available for 816 participants, of whom 600 participants without CKD at baseline were eligible for inclusion in the retrospective analysis. The HTGW phenotype was defined as a waist circumference of 90 cm or more and triglyceride concentrations of 2.0 mmol/L or more in males or a waist circumference of 85 cm or more and triglyceride concentrations of 1.5 mmol/L or more in females. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2 and/or proteinuria (urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g). Multivariable logistic regression analyses were performed to evaluate the relationship between the HTGW phenotype and CKD.ResultsIn 2013, the prevalence of CKD among older adults was 31.03%, and the prevalence of CKD in the HTGW phenotype group was 37.81%. Over a 7-year observation period, 195 individuals developed CKD, with an incidence rate of 32.50%. Statistically significant associations were observed between the HTGW phenotype and CKD in older adults in both cross-sectional surveys and retrospective analyses, with odds ratios and 95% confidence intervals of 1.38 (95% CI: 1.03–1.86, P = 0.033) and 2.27 (95% CI: 1.30–3.97, P = 0.004), respectively, after adjustment for confounders.ConclusionsIn this community-based cohort study, the HTGW phenotype was confirmed to be independently associated with an increased risk of prevalent and incident CKD in older adults aged 60 years and above in Tianjin, China.

Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older Adults: A Population-Based Cohort Study.

Background:The risk of hyperkalemia is elevated in chronic kidney disease (CKD); however, the initial and recurrent risk among older individuals is less clear.Objectives:We set out to examine the initial and 1-year recurrent risk of hyperkalemia by level of kidney function (estimated glomerular filtration rate, eGFR) in older adults (≥66 years old).Design:Population-based, retrospective cohort studySettings:Ontario, CanadaParticipants:905 167 individuals (≥66 years old) from 2008 to 2015.Measurements:Serum potassium valuesMethods:Individuals were stratified by eGFR (≥90, 60-89, 30-59, 15-29 mL/min/1.73 m2) and examined for the risk of incident hyperkalemia (K ≥ 5.5 mEq/L) using adjusted Cox proportional hazards models. The 1-year risk of recurrent hyperkalemia was examined using multivariable Andersen-Gill models.Results:Among a population of 905 167 individuals (15% eGFR ≥ 90, 58% eGFR 60-89, 25% eGFR 30-59, 3% eGFR 15-29) with a potassium measurement, there were a total of 18 979 (2.1%) individuals with hyperkalemia identified. The event rate (per 1000 person-years) and adjusted hazard ratio (HR) of hyperkalemia was inversely associated with eGFR (mL/min; eGFR >90 mL/min: 8.8, referent, 60-89 mL/min: 11.8 HR 1.41; eGFR 30-59: 39.8, HR 4.37; eGFR 15-29: 133.6, 13.65) and with an increasing urine albumin-to-creatinine ratio (ACR, mg/mmol; ACR< 3: 14, referent, ACR 3-30: 35.1, HR 1.98; ACR >30: 93.7, 4.71). The 1-year event rate and adjusted risk of recurrent hyperkalemia was similarly inversely associated with eGFR (eGFR ≥ 90: 10.1, referent, eGFR 60-89: 14.4, HR 1.47; eGFR 30-59: 54.8, HR 4.90; eGFR 15-29: 208.0, HR 12.98). Among individuals with a baseline eGFR of 30 to 59 and 15 to 29, 0.9 and 3.8% had greater than 2 hyperkalemia events. The relative risk of initial and recurrent hyperkalemia was marginally higher with RAAS blockade. Roughly 1 in 4 individuals with hyperkalemia required hospitalization the day of or within 30 days after their hyperkalemia event.Limitations:Limited to individuals aged 66 years and above.Conclusions:Patients with low eGFR are at a high risk of initial and recurrent hyperkalemia.Trial registration: N/A

Dietary Total Antioxidant Capacity and Its Association with Renal Function and Progression of Chronic Kidney Disease in Older Adults: a Report from a Developing Country.

While evidence exists for an association between the dietary total antioxidant capacity (DTAC), mortality, metabolic syndrome, and cardiovascular diseases, data about DTAC and renal function, and progression of chronic kidney disease (CKD) are scarce. This study aimed to determine the associations between DTAC, renal function, and progression of CKD in older adults. The present cross-sectional study consisted of 226 older adults aged ≥ 60 years old from five districts of Tehran, Iran. DTAC was estimated using the oxygen radical absorbance capacity (ORAC) method. Dietary intake, socio-demographic data, medical history, and anthropometric measurements were collected using a validated questionnaire. The estimated glomerular filtration rate (eGFR) was assessed from serum creatinine. Albumin to creatinine ratio (ACR) was calculated by dividing albumin concentration by creatinine concentration and reported as mg/g. The DTAC ranged from 112.8 to 2,553.9. Analyses indicated that DTAC was not associated with eGFR (p = 0.35) and ACR (p = 0.91) even after controlling for confounding variables. Additionally, in logistic regression, no association between eGFR < 60 mL/min/1.73 m2 (p = 0.32) and ACR ≥ 30 mg/g (p = 0.32) with DTAC was observed, which was independent of confounding variables. We observed that more compliance with DTAC is not associated with renal function and CKD progression. Further studies are needed to confirm the findings of the present study in larger samples on different populations.

Abstract P060: Sedentary Behavior is Directly Associated With Higher Prevalence of Chronic Kidney Disease in Older Adults: The Framingham Heart Study

Introduction: Self-reported physical inactivity and sitting time have been associated with a greater prevalence of chronic kidney disease (CKD) in middle-aged populations. However, data are limited regarding the association of objectively-assessed physical activity and sedentary behavior with prevalence of CKD among older adults. Hypothesis: We hypothesized that higher physical activity and less sedentary time will individually and conjointly be associated with a lower prevalence of CKD in older adults. Methods: We evaluated 1,318 Framingham Offspring cohort participants (mean age 69.3 years, 53.9% women) with accelerometry-derived physical activity data (wear time ≥ 10 hours/day for at least 4 days) at examination 9 (2011-2014). CKD was defined as an eGFR &lt; 60 ml/min/1.73 2 and/or urine albumin-to-creatinine ratio (UACR) ≥ 25/35 micrograms/mg (men/women) at examination 9. Multivariable logistic regression models were used to relate physical activity and sedentary time with the prevalence of CKD adjusting for covariates (Table). In sensitivity analysis to mitigate reverse causality, we excluded participants with more advanced CKD (eGFR&lt;30 ml/min/1.73 2 ). Results: Men spent more time in moderate to vigorous physical activity (MVPA) (mean 21.7 min/day) and less time in sedentary time (mean, 660.7±76.9 min/day), compared to women (mean MVPA, 15.6 min/day; mean sedentary time, 675.8±70.5 min/day). Overall, 279 participants had prevalent CKD (20.8%; 127 women). Higher sedentary time was associated with a higher prevalence of CKD after adjusting for risk factors and MVPA in sensitivity analysis, the association remained significant. MVPA was inversely associated with CKD prevalence in minimally-adjusted models only. Conclusions: Our cross-sectional observations on a sample of older adults are consistent with the notion that reduction of sedentary time in the elderly may have salutary effects on kidney function. Additional studies of multiethnic cohorts are warranted to confirm our observations.

Metabolic Syndrome and Smoking Are Associated with Future Development of Advanced Chronic Kidney Disease in Older Adults

Introduction: Metabolic syndrome (MetS) and smoking have been identified as risk factors for chronic kidney disease (CKD) in cross-sectional studies in various age groups, but longitudinal data on progression of CKD in older adults are limited. Our objectives were to examine whether MetS and its components and smoking predict the onset of CKD stage 3b (CKD-3b) in older adults. Methods: A subset of participants of the Einstein Aging Study who were free of diabetes, dementia, and CKD-3b at enrollment were included in this analysis. CKD-3b was defined as an estimated glomerular filtration rate <45 ml/min/1.73 m². Cox proportional hazards models were used in these analyses. Results: In total, 413 ≥70-year-old individuals were eligible for this study. 65.4% were female and 26.6% were black. 22.3% of the participants had MetS at baseline, 4.4% were active smokers, and 6.1% developed CKD-3b over a mean of 4 years of follow-up. MetS and smoking independently predicted incident CKD in our fully adjusted model (hazard ratio 3.65, 95% CI 1.20-10.60, p = 0.022; hazard ratio 29.69, 95% CI 4.47-197.23, p = 0.000). Conclusion: MetS and smoking are associated with an increased incidence of CKD-3b. These risk factors are modifiable, easily identified and prevented through better health care practice and early diagnosis.

Prevalence and Correlates of Renal Disease in Older Lithium Users: A Population-Based Study

Lithium is an important treatment for mood disorders, but concern about its association with renal disease has contributed to its limited use, particularly in older adults. Because high-quality evidence examining renal disease in this population is lacking, this study aims to quantify the prevalence and identify clinical correlates of renal disease in geriatric lithium users. In a population-based cross-sectional study on 2,480 lithium users aged 70 or more years, the authors searched the provincial administrative health data from Ontario, Canada between April 1, 2005 and March 31, 2011. Prevalence of chronic kidney disease (CKD), acute kidney injury (AKI), and nephrogenic diabetes insipidus (NDI) was measured using International Classification of Diseases, Tenth Revision codes. Logistic regression analyses were used to identify independent correlates of renal disease. The 6-year prevalence rates of CKD, AKI, and NDI were 13.9%, 1.3%, and 3.0%, respectively. Hypertension (odds ratio [OR]: 2.05; 95% confidence interval [CI]: 1.50-2.79), diabetes mellitus (OR: 1.86; 95%CI: 1.45-2.38), ischemic heart disease (OR: 1.65; 95% CI: 1.24-2.20), NDI (OR: 2.54; 95% CI: 1.47-4.40), AKI (OR: 11.7; 95% CI: 5.26-26.1), lithium use for more than 2 years (OR: 1.71; 95% CI: 1.05-2.81), loop diuretic use (OR: 1.74; 95% CI: 1.26-2.41), hydrochlorothiazide use (OR: 1.48; 95% CI: 1.07-2.05), and atypical antipsychotic use(OR: 1.49; 95% CI: 1.17-1.89) were all independently associated with CKD. Older lithium users have high rates of CKD. Lithium use duration was independently associated with CKD. Longitudinal studies including individuals without lithium exposure will be necessary to confirm whether lithium is indeed a risk factor for CKD in older adults.

Chronic Kidney Disease—A Challenge for All Ages

OVER THE PAST DECADE, CHRONIC KIDNEY DISEASE (CKD), defined as impaired glomerular filtration rate (GFR) or elevated urine albumin excretion, has been increasingly recognized as an important risk factor contributing to cardiovascular disease and death. Moreover, the prevalence of CKD has increased, with CKD now affecting approximately 13.1% of Americans. This increase has been driven by the increasing prevalence of the most common risk factors for CKD, including diabetes, hypertension, and—perhaps most important—older age. Among US adults aged 70 years or older, the prevalence of CKD has been estimated to be more than 45%. However, the clinical implications of CKD in elderly persons remain uncertain. In particular, substantial controversy exists regarding whether CKD represents a true disease or whether loss of GFR is simply part of the natural aging process. In this issue of JAMA, the CKD Prognosis Consortium provides valuable new data regarding the importance of CKD in older adults. Based on findings from more than 2 million participants from 46 cohorts, the authors report that among older adults, CKD is associated with excess mortality risks that are as high as or higher than the excess risks observed among middle-aged adults. For example, after accounting for a number of potential confounding variables, for participants aged 18 to 54, 55 to 64, 65 to 74, or 75 or more years at baseline, an estimated GFR of 45 vs 80 mL/min/1.73 m was associated with 9.0, 12.2, 13.3, or 27.2 additional estimated deaths per 1000 person-years of follow-up, respectively. These data, combined with knowledge that CKD is more prevalent with advancing age, identify older adults as a population for which CKD has exceptional individual and public health importance. Risks of end-stage renal disease (ESRD) were also examined by age. For older adults, absolute incidence rates of ESRD were substantially lower than absolute mortality rates. For example, for participants aged 75 years or older with an estimated GFR of 45 mL/min/1.73 m, the estimated average incidence rate of ESRD was 9.8 per 1000 personyears of follow-up, compared with an estimated average mortality rate of 85.0 per 1000 person-years. In addition, associations of CKD with risk of ESRD were attenuated comparing older with younger participants. These data are consistent with prior reports demonstrating that older adults are less likely to receive kidney replacement treatment for ESRD than younger individuals and that the poor outcomes of older adults with CKD occur predominantly without progression to treated ESRD. The CKD Prognosis Consortium study has 2 main salient features. First, it analyzes data across 46 cohort studies that include more than 2 million participants. This yields results that are broadly applicable and provides adequate statistical power to evaluate whether the association of CKD with health outcomes varies by age. Second, excess risk is evaluated on the clinically relevant additive scale, in addition to the more commonly applied relative scale. Differences in absolute risk calculated on the additive scale reflect the marginal risk of a risk factor, such as CKD, accounting for the “baseline” risk among unexposed members of a population. These absolute risk differences can be easily compared with those of other risk factors or, in the case of treatment studies, can be used to directly compare benefits with harms and calculate the number needed to treat. Moreover, if an exposure is assumed to be causally related to the outcome examined, the absolute risk difference most meaningfully captures the public health benefit that could be achieved by preventing or effectively treating the risk factor. What should the medical community conclude from the new data? Older adults with CKD should be recognized as patients at high risk of death. In CKD, excess mortality risk is largely attributable to cardiovascular disease, although other disease pathways are also important. Therefore, all efforts should be made to apply treatment strategies that are proven effective for the primary or secondary prevention of cardiovascular disease in this population and are appropriate to the individual. These may

A better diet quality is associated with a reduced likelihood of CKD in older adults

Background and aimsStudies of diet in relation to chronic kidney disease (CKD) have focused on individual nutrients. The relationship between overall patterns of food intake and renal function has not been well explored. We aimed to investigate the associations between diet quality with the prevalence, incidence and progression of CKD in a cohort of older adults. Methods and Results1952 participants aged ≥50 years at baseline were examined between 1992–1994 and 2002–2004. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Baseline biochemistry including serum creatinine was measured. CKD was defined as MDRD estimated glomerular filtration rate (eGFR) <60 mL min−1.1.73 m−2.Participants in the highest quartile of mean TDS compared to those in the first quartile (reference), had a 41% reduced likelihood of having eGFR <60 mL min−1.1.73 m−2, [multivariable-adjusted odds ratio, OR, 0.59 (95% confidence intervals, CI, 0.41–0.85), P-trend = 0.005]. Each unit increase in TDS was associated with a 15% decrease in the odds of having prevalent CKD, multivariable-adjusted OR 0.85 (95% CI 0.74–0.97). A non-significant, inverse association between TDS and CKD incidence was observed (P-trend = 0.10). ConclusionOlder adults with better diet quality had a reduced likelihood of having eGFR <60 mL min−1.1.73 m−2. Adherence to dietary guidelines were not prospectively associated with CKD incidence or progression. Further studies with adequate power are warranted to assess the longitudinal association between diet quality and CKD.

Age, eGFR, and CKD Complications

Age, eGFR, and CKD Complications