Elderly Chronic Kidney Disease Research Articles

Association of C-Reactive Protein, Tumor Necrosis Factor-Alpha, and Interleukin-With Chronic Kidney Disease in Elderly.

Association of C-Reactive Protein, Tumor Necrosis Factor-Alpha, and Interleukin-With Chronic Kidney Disease in Elderly.

Physical activity modifies cognitive impairment-associated mortality risks among chronic kidney disease

BackgroundOlder chronic kidney disease (CKD) patients frequently face unrecognized cognitive impairment and excess mortality. Physical activity (PA) reduces cognitive decline but whether PA modifies cognitive impairment-associated mortality remains unknown. MethodsFrom 2005 to 2011, 30,561 older Taiwanese CKD patients were enrolled. Patients were divided into intact cognition (≥8 scores), mild (6–7 scores), and severe (≤5 scores) cognitive impairment groups by the Short Portable Mental Status Questionnaire (SPMSQ), and were also categorized into high-PA (≥60 min/week of moderate-intensity PA), low-PA (20–60 min/week) or inactive (<20 min/week) groups. Cox regression was conducted to evaluate the individual and joint associations of cognitive impairment and PA on all-cause and cardiovascular mortality. ResultsAfter a median follow-up of 4.52 years, the all-cause mortality were higher in CKD patients with severe (multivariable-adjusted hazard ratio [aHR] 2.31; 95% confidence interval [CI] 2.05–2.60) and mild (aHR 1.74; CI 1.51–1.99) cognitive impairment than cognitively intact ones. Remarkably, decreased PA amount interacted and amplified the cognitive impairment-associated mortality risks. Notably, the high-PA status linked to lower overall mortality risks both in mild (aHR 0.65; CI 0.45–0.93) and severe (aHR 0.73; CI 0.54–0.99) cognitively-impaired patients as compared to inactivity. Survival tree analysis indicated the least mortality in those with high PA and >8 SPMSQ scores. Similar associations were found in the cardiovascular mortality. LimitationsResidual confounding and single ethnicity. ConclusionsCognitive impairment defined by SPMSQ was progressively associated with higher mortality among elderly CKD. Higher PA linked to lower cognitive impairment-associated death risks, and could be promoted for longevity benefits.

BRD4 plays an antiaging role in the senescence of renal tubular epithelial cells.

Age-related kidney failure is often induced by a decrease in the bioavailability of tubular epithelial cells in elderly chronic kidney disease (CKD) patients. BRD4, an epigenetic regulator and a member of the bromodomain and extraterminal (BET) protein family, acts as a super-enhancer (SE) organizing and regulating genes expression during embryogenesis and cancer development. But the physiological function of BRD4 in normal cells has been less studied. This study aimed to research certain biological roles of BRD4 in the process of normal cell aging and discuss the potential mechanisms. In this study, we investigated the biological functions of BRD4 proteins in the aging of renal tubular cells. At first, we used a D-galactose (D-gal) and BRD4 inhibitor (Abbv-075) to replicate kidney senescence in vivo. D-gal and Abbv-075 were then used to measure the aging-related changes, such as changes in cell cycle, β-galactosidase activity, cell migration, and p16 protein expression in vitro. At last, we knocked down and over-expressed BRD4 to investigate the aging-related physiological phenomena in renal tubular cells. In vitro, D-gal treatment induced noticeable aging-related changes such as inducing cell apoptosis and cell cycle arrest, increasing β-galactosidase activity as well as up-regulating p16 protein expression in primary human tubular epithelial cells. In the aging mice model, D-gal significantly induced renal function impairment and attenuated BRD4 protein expression. At the same time, the BRD4 inhibitor (Abbv-075) was able to mimic D-gal-induced cell senescence. In vivo, Abbv-075 also decreased kidney function and up-regulated p21 protein expression. When we knocked down the expression of BRD4, the senescence-associated β-galactosidase (SA-β-gal) activity increased dramatically, cell migration was inhibited, and the proportion of cells in the G0/G1 phase increased. Additionally, the knockdown also promoted the expression of the senescence-related proteins p16. When the renal tubular cells were overexpressed with BRD4, cell aging-related indicators were reversed in the D-gal-induced cell aging model. BRD4 appears to have an active role in the aging of renal tubular cells in vivo and in vitro. The findings also suggest that BRD4 inhibitors have potential nephrotoxic effects for oncology treatment. BRD4 may be a potential therapeutic biomarker and drug target for aging-related kidney diseases, which warrants additional studies.

Effects of Dietary Intervention on Nutritional Status in Elderly Individuals with Chronic Kidney Disease.

The prevalence of chronic kidney disease (CKD) is rising, especially in elderly individuals. The overlap between CKD and aging is associated with body composition modification, metabolic abnormalities, and malnutrition. Renal care guidelines suggest treating CKD patient with a low-protein diet according to the renal disease stage. On the other hand, geriatric care guidelines underline the need for a higher protein intake to prevent malnutrition. The challenge remains of how to reconcile a low dietary protein intake with insuring a favorable nutritional status in geriatric CKD populations. Therefore, this study aims to evaluate the effect of a low-protein adequate energy intake (LPAE) diet on nutritional risk and nutritional status among elderly CKD (stage 3-5) patients and then to assess its impact on CKD metabolic abnormalities. To this purpose, 42 subjects [age ≥ 65, CKD stage 3-5 in conservative therapy, and Geriatric Nutritional Risk Index (GNRI) ≥ 98] were recruited and the LPAE diet was prescribed. At baseline and after 6 months of the LPAE diet, the following data were collected: age, sex, biochemical parameters, anthropometric measurements, body composition, and the GNRI. According to their dietary compliance, the subjects were divided into groups: compliant and non-compliant. For the compliant group, the results obtained show no increased malnutrition risk incidence but, rather, an improvement in body composition and metabolic parameters, suggesting that the LPAE diet can provide a safe tool in geriatric CKD patients.

Abstract 15816: Contemporary Nationwide Trends in Major Adverse Cardiovascular and Cerebrovascular Events Among Elderly Chronic Kidney Disease Patients With versus Without Obstructive Sleep Apnea and Associated Sex and Racial Disparities, 2016-2019

Background: End-stage renal disease (ESRD) patients with more intensive renal replacement therapy have been shown to alleviate the severity of sleep apnea, specifically obstructive sleep apnea (OSA). Our study aims to analyze the trends in combined cardiovascular events among geriatric CKD patients, comparing those with and without OSA. Methods: We conducted a comprehensive analysis using nationwide data from 2016 to 2019 to identify geriatric CKD patients based on ICD-10 codes. A comparative assessment was performed between elderly CKD patients with and without OSA, examining their baseline characteristics and potential disparities related to sex and race. Results: From 2016 to 2019, 14,157,877 geriatric CKD patients were analyzed. OSA is more prevalent in men (60.5% v/s 50.5%) and in the white race(79.3% v/s 72.5%) compared to the non-OSA group. In the OSA group, men had an increased prevalence of major adverse cardiovascular and cerebrovascular events (MACCE) (12.0% v/s 9.7%) and acute myocardial infarction (AMI)(7.0%-5.2%) with p&lt;0.001. OSA patients had a decrease in all-cause mortality (3.2% v/s 4.7%), AMI (6.3% v/s 7.2%), and cardiac arrest (1.0% v/s 1.3%), with p&lt;0.001. Patient’s on BiPAP/CPAP therapy have further decreased ODD’s of MACCE and is statistically significant, p&lt;0.001. Conclusion: OSA patients with or without BiPAP/CPAP are associated with decreased MACCE in elderly CKD patients. The potential impact of Interventions like BiPAP/CPAP therapy on kidney function and cardiovascular outcomes requires further investigation to better understand and manage chronic kidney disease and OSA cardiovascular paradox.

Comprehensive geriatric assessment and drug burden in elderly chronic kidney disease patients

Abstract Objectives Chronic kidney disease (CKD) is a condition characterized by atherosclerosis, cognitive impairment, physical limitations, biochemical abnormalities, and vascular aging. The proportion of those with a diagnosis of CKD in the older is increasing. With comprehensive geriatric assessment, it could be possible to detect the disorders that are related to biological aging. The aim is to evaluate geriatric syndromes like frailty, cognitive dysfunction, malnutrition, and polypharmacy in an aged population with pre-dialytic CKD (stages 3a–5), and to investigate possible relations with biochemical features and anticholinergic drug burden (ADB). Methods One hundred and fifty-six CKD patients aged 60 and older and 164 healthy controls were included in the study. Geriatric parameters that were used for the evaluation of the groups were, Clinical Frailty Index; Charlson Comorbidity Index; Montreal Cognitive Assessment and Mini Nutritional Assessment Short-Form. Besides, biochemical parameters and ADB defined with 3 scales Anticholinergic Burden Classification (ABC), Chew’s scale, and Drug Burden Index were recorded. Results Despite being younger, CKD patients had higher comorbidity and frailty scores than the controls. Patients and controls had similar nutritional status, and cognitive function test results. Frailty was an important predictor for geriatric parameters and eGFR. ABC score was higher in the CKD group in ADB scale. Conclusions Frailty and polypharmacy are more prevalent than expected in older with CKD. In addition, anticholinergic burden and polypharmacy may form causal links with one and other and lead to increased mortality rates especially with frailty. Therefore, geriatric assessment and appropriate ADB evaluation may be recommended in CKD patients.

Chronic kidney disease in the elderly and frail patient: perspectives with opinions and comments.

Chronic kidney disease is common in elderly and frail people. The importance of age in staging chronic kidney disease is discussed as well as the possible constraints of staging what is actually a 'continuum' of disease progression. Frailty is a biological state characterized by the decline of several physiological systems and strongly correlated with adverse health outcomes, including mortality. Frailty is measured by the Comprehensive Geriatric Assessment, which focuses on quantitative rating scales that determine not only the clinical profile and pathological risk of frail individuals, but also their residual capacities, functional status, and quality of life. There is circumstantial evidence that Comprehensive Geriatric Assessment can improve both survival and quality of life in elderly chronic kidney disease patients. Despite the long list of emerging risk factors and markers of chronic kidney disease progression, it is the authors' opinion that a single biochemical parameter can hardly cover the complexity of chronic kidney disease in elderly and frail patients. Among the numerous clinical scores proposed, the European Renal Best Practice guidelines recommend the Renal Epidemiology and Information Network score and the Kidney Failure Risk Equations. The former provides a reasonable estimate of short-term mortality risk, the latter provides the risk of chronic kidney disease progression. In conclusion, the elderly individual with advanced chronic kidney disease is often comorbid and frail with peculiarities in terms of disease grading, clinical assessment and monitoring. The time has come to reshape the care of this growing number of patients by focusing on multidisciplinary teams both in the hospital and in the community.

Retracted: Efficacy and Mechanism of Roxadustat plus Oral Iron in the Treatment of Elderly Chronic Kidney Disease with Anemia.

[This retracts the article DOI: 10.1155/2022/9192655.].

Association of the malnutrition-inflammation score with physical function and functional disability in elderly patients with chronic kidney disease.

To describe nutritional status and inflammation of elderly patients with chronic kidney disease and to confirm the association between a Malnutrition-Inflammation Score and physical func-tion and functional disability. A total of 221 chronic kidney disease patients (aged ≥60 years) were included. A Malnutrition-Inflammation Score was used to assess malnutrition and inflammation. Physical function was assessed using the SF-12. Functional status was evaluated using basic activities of daily living and instrumental activities of daily living. Thirty percent of participants had a Malnutrition-Inflammation Score ≥6, which denoted poor nutritional status. Participants with a Malnutrition-Inflammation Score ≥6 had decreased concentration of hemoglobin, albumin, prealbumin, handgrip strength and walking speed and increased concentration of inflammatory markers, including CRP, IL-6 and fibrinogen. Physical function and physical component summary were lower and basic activities of daily living dependence and instrumental activities of daily living dependence were higher among patients with higher Malnutrition-Inflammation Score than those with a lower Malnutrition-Inflammation Score. The Malnutrition-Inflammation Score was an independent risk factor for physical function and instrumental activities of daily living dependence. The elderly chronic kidney disease patients with a high Malnutrition-Inflammation Score had a decreased physical function and an increased risk of functional instrumental activities of daily living dependence.

Timed-averaged blood pressure showed a J-curve association with stroke in elderly chronic kidney disease patients

Background The risk factors for stroke in elderly patients with chronic kidney disease (CKD) are not well understood. This study aimed to explore the influence of systolic blood pressure (SBP) on the risk of stroke in a large cohort of elderly patients with stage 3–5 CKD. Methods We retrospectively identified 665 patients hospitalized in Beijing Friendship Hospital from January 2000 to December 2021. Patients were followed up until the occurrence of stroke or death. Multivariate logistic regression analysis and Cox proportional hazard models were used to analyze the risk factors for stroke according to the presence or absence of CKD. The association between CKD and stroke was further evaluated regarding the role of SBP in the hypertensive population. Results In individuals with CKD, a J-shaped relationship was observed between SBP levels and the risk of stroke. Participants with CKD and an SBP less than 125 mmHg had a significantly higher cumulative stroke survival rate than those whose SBP was between 125 and 139 mmHg. The cumulative stroke survival rate increased progressively for those with SBP higher than 140 mmHg. This J-shaped relationship was not found in patients without CKD. Conclusion In elderly patients with CKD, those with the lowest BP are at increased risk for incident stroke. This phenomenon could be different from that in the general population.

Association between depressive symptoms and bone density in elderly patients with non-dialysis dependent chronic kidney disease

BackgroundDepression is a disease that is commonly accompanied by elderly chronic kidney disease (CKD) patients, but when the two diseases are accompanied, etiology or combination are not well known. We aimed to evaluate the etiology of CKD and comorbid depression by investigating bone disorders that are observed in persons affected by both CKD and depression. MethodsWe conducted a cross-sectional study with a total of 646 patients with CKD. We compared the sociodemographic factors, kidney function, markers for CKD-Mineral and Bone Disorder (CKD-MBD) and bone mineral density according to the depressive symptoms. We conducted a univariate and multivariate logistic regression analysis to calculate odd ratios (95 % confidence interval) between depressive symptoms and low bone mineral density. ResultsIndividuals with CKD and depressive symptoms were associated with lower level of education attained, living alone, exercising less, low 24-hour urine phosphorus, and low bone density. Depressive symptoms were significantly associated with low bone density in lowest parts (1.55 [1.06–2.29]) and in total hip (1.72 [1.17–2.53]) even after adjusting for diabetes mellitus, hypertension, kidney function, proteinuria, age, sex, smoking, and body mass index. LimitationsA cross-sectional design was used in this study and the bone biopsy for diagnosis of CKD-MBD was not done because of invasiveness and practical difficulties. ConclusionLow bone density was associated with depressive symptoms in elderly patients with non-dialysis chronic kidney disease.

Efficacy and Mechanism of Roxadustat plus Oral Iron in the Treatment of Elderly Chronic Kidney Disease with Anemia.

Objective For investigating the efficacy and mechanism of Roxadustat + oral iron in the treatment of elderly chronic kidney disease (CKD) complicated with anemia. Methods A total of 100 elderly patients with CKD and anemia admitted to our hospital between April 2020 and December 2021 were enrolled as research subjects, and the patients were assigned to control group (Con group, n = 50) or experimental group (Exp group, n = 50). The patients in the Con group were given oral iron, and those in the Exp group were given Roxadustat capsule based on the Con group. Both groups were given subcutaneous injection of recombinant human erythropoietin. The clinical efficacy, anemia indexes, iron metabolism indexes, inflammatory indexes, and adverse reactions were compared between the two groups. Results The Exp group showed a notably higher treatment effective rate than the Con group (P < 0.05). After treatment, the anemia indexes, iron metabolism indexes, and inflammatory indexes in the Exp group were notably better than those in the Con group (P < 0.05). The Exp group showed a notably lower incidence of adverse reactions during treatment than the Con group (P < 0.05). Conclusion Roxadustat plus oral iron yields a pronounced clinical efficacy in the therapy of elderly patients with CKD and anemia.

The efficacy of rehabilitation for elderly chronic kidney disease patients: a retrospective, single-center study.

As the geriatric population is growing rapidly, so is the prevalence of chronic kidney disease (CKD). Suitable rehabilitation programs are needed to decrease disability and improve functionality to maintain independence in activities of daily life. To assess the impact of CKD on the efficacy of rehabilitation in the geriatric population. Retrospective single-center cohort study, demographic and clinical data of 190 elderly, non-dialysis dependent CKD patients, who underwent rehabilitation, during 2016-2020 were analyzed. Early CKD patients had longer duration of rehabilitation as compared with advanced CKD (32.6 ± 19.5 vs. 25.1 ± 17.6days, p = 0.011) and tended to be more independent at discharge (37.2% vs. 27.9%, respectively; p < 0.001). Duration of rehabilitation, Mini-Mental State Examination (MMSE), Functional Independence Measurement (FIM) admission and estimated GFR were important predictors of FIM at discharge. Age was negatively correlated with admission FIM, eGFR, MMSE, and discharge FIM. The odds ratio for mortality among patients with advanced as compared to early CKD was 2.197 (CI 95% 1.159-4.166, p = 0.015). Existing rehabilitation programs raise questions of suitability for the consistently aging population, play an indispensable part in the goal of achieving functional independence in the elderly and should promote further investigation of the efficacy of rehabilitation for CKD patients. Advanced CKD was associated with lower FIM at admission and discharge, shorter duration of rehabilitation and more dependence at discharge, as compared to patients with early CKD. Implementing a multidisciplinary team, focused on the specific needs of geriatric CKD patients, with clear, objective parameters and goals may lead to better rehabilitative outcomes, with decreased public and private costs of ongoing care.

Blood Pressure Control in Elderly Chronic Kidney Disease Patients.

In elderly chronic kidney disease (CKD) patients, isolated systolic hypertension is common, the rate of renal function decline is slow, and there is a high possibility of physical damage due to side effects such as drug use-related orthostatic hypotension. Therefore, there are still many questions about whether lowering blood pressure in elderly patients will actually improve prognosis. Since many blood pressure-related clinical studies exclude advanced CKD and the elderly, it is particularly difficult to define target blood pressure in these populations. A randomized controlled trial is needed to establish optimal blood pressure targets and treatment strategies in elderly patients with CKD. This review seeks to summarize the guidelines available at this time.

Abstract P131: RISK FACTORS AND WAYS OF INFLUENCING MASKED UNCONTROLLED HYPERTENSION

Purpose: to establish risk factors of masked uncontrolled hypertension (MUCH) and clarify how fixed combinations can affect blood pressure (BP) control. Methods: We examined 70 patients with hypertension. The initial assessment of the effectiveness of antihypertensive therapy was carried out 3 months after its appointment. Of the 70 patients, 63 were able to reach essential office BP reduction point (these patients were additionally scheduled for ABPM). Results: Among 63 patients in whom hypertension was controlled according to office BP data, 58.7% had insufficient BP control according to ABPM data. Among patients with insufficient control of out-of-office BP, there were significantly more patients with circadian rhythm disorders (p=0.000). An assessment of possible factors for the development of MUCH showed that elderly age occurred in 78.4%, male sex - in 59.5%, smoking - in 70.3%, stress - in 78.4%, various sleep disorders - in 45.9%, diabetes mellitus (DM) - in 56.8%, obesity - in 67.6%, insulin resistance (IR) - in 73%, chronic kidney disease (CKD) - in 35.1% patients with MUCH. Analysis of patient therapy showed that out of 37 patients with MUCH, 7 patients received monotherapy, 9 patients - free dual combinations, and 21 patients - fixed dual combinations. For patients with MUCH, antihypertensive therapy was strengthened: patients who had previously received monotherapy or free combinations were transferred to double fixed combinations (both drugs acted for 24 hours), and those patients who received double fixed combinations were transferred to triple fixed combinations. Evaluation of therapy after 3 months showed that of 37 patients with initially established MUCH, complete BP control was achieved in 86.5% (in the remaining 13.5%, despite sufficient office BP control, MUCH was maintained according to ABPM data). Conclusions: In inadequate control of out-of-office BP, disturbances of the circadian rhythm are more common than with complete BP control. MUCH is associated with such risk factors as elderly age, male gender, smoking, stress, sleep disturbances, DM, obesity, IR, and CKD. Strengthening antihypertensive therapy contributed to the achievement of both office and out-of-office BP in 86.5% of patients with previously established MUCH.

Masked uncontrolled hypertension: risk factors and ways of influence

According to the current Guidelines, the effectiveness of antihypertensive therapy is assessed mainly by achieving target levels of office blood pressure (BP). However, masked uncontrolled hypertension (MUCH) increases the risk of cardiovascular events, therefore deserves timely diagnosis and correction.&#x0D; Objective — to establish the prevalence and risk factors of MUCH and to clarify how the use of fixed combinations can affect the control of office and out‑of‑office BP.&#x0D; Materials and methods. We examined 70 patients with arterial hypertension (AH) of 1 — 2 degrees. The initial assessment of the effectiveness of antihypertensive therapy was carried out 3 months after its appointment. Of the 70 patients initially enrolled in the study, 63 were able to reach essential office BP reduction point (&lt; 140/90 mm Hg, according to 2020 ISH Guidelines). Patients who reached essential point of office BP reduction were additionally provided 24 hour ambulatory BP monitoring (ABPM) to detect possible MUCH.&#x0D; Results. It was found that among 63 patients in whom AH was controlled according to office BP data, 37 patients (58.7 %) had insufficient hypertension control according to ABPM data (they had MUCH). An assessment of possible factors for the development of MUCH showed that elderly age occurred in 29 (78.4 %) patients with MUCH, male sex — in 22 (59.5 %) patients, smoking — in 26 (70.3 %) patients, stress — in 29 (78.4 %) patients, various sleep disorders — in 17 (45.9 %) patients, diabetes mellitus (DM) — in 21 (56.8 %) patients, obesity — in 25 (67.6 %) patients, insulin resistance (IR) — in 27 (73 %) patients, chronic kidney disease (CKD) — in 13 (35.1 %) patients. Analysis of patient therapy showed that out of 37 patients with MUCH, 7 patients received monotherapy, 9 patients received free dual combinations (ACE inhibitor/sartan + calcium antagonist/diuretic), and 21 patients received fixed dual combinations. In accordance with 2018 ESC/ESH Guidelines, antihypertensive therapy was strengthened for patients with MUCH: those patients who had previously received monotherapy or free combinations were transferred to double fixed combinations (ACE inhibitors/sartans + calcium antagonist/diuretic), in which both drugs acted for 24 hours, and those patients with MUCH who received double fixed combinations were transferred to triple fixed combinations. Evaluation of antihypertensive therapy after 3 months showed that of 37 patients with initially established MUCH, complete BP control was achieved in 32 (86.5 %) patients (in the remaining 5 patients, despite sufficient control of office BP, MUCH was maintained according to ABPM data).&#x0D; Conclusions. In inadequate control of out‑of‑office BP, various disturbances of the circadian rhythm (with a predominance of the non‑dipper rhythm) are more common than with complete BP control. MUCH is associated with such risk factors as elderly age, male gender, smoking, stress, sleep disturbances, DM, obesity, IR, and CKD. Strengthening antihypertensive therapy contributed to the achievement of both office and out‑of‑office BP in 86.5 % of patients with previously established MUCH.&#x0D;

A prospective study for the assessment of frailty in elderly chronic kidney disease patients

Background: Frailty is a common clinical syndrome in the elderly that may be associated with increased risk of health complications and decreased physical functioning. Early screening of individuals who are at high risk of frailty is required to allow timely intervention for the prevention and reversal of frailty. There is a paucity of information on frailty among the Indian elderly population and especially among the elderly chronic kidney disease (CKD) population. Hence, the aim of the present study was to find out the occurrence of frailty in elderly patients with CKD. Methods: The present prospective cross-sectional study was conducted from an outpatient clinic of a tertiary care hospital. We enrolled 200 participants aged 60 years or above, dividing them into two groups as case (included those with CKD stage 3 and above who were not on dialysis with or without any coexisting comorbidities) and control groups (included those non-CKD patients with or without any coexisting comorbidities). Exclusion criteria were patients with prior history of stroke with neurological complications, dementia or cognitive deficit, severe Parkinson's disease, and nonambulatory. Assessment of frailty was done using the short physical performance battery test (SPPBT) and handgrip strength (HGS). Assessment of HGS was done using a JAMAR hand dynamometer. The data were analyzed using SPSS V 20.0. Results: Majority of the participants were male in the case group (58%), while they were almost equal in the control group (51%). Most of the participants belonged to the age groups of 60–70 years with a mean age of 68.8 ± 5.90 years and 67.99 ± 5.93 years in case and control groups, respectively. In the case group, more than half of the patients had CKD stage 4 (57%), followed by CKD stage 5 (36%). There was no significant difference in diabetes mellitus (P = 0.41), hypertension (P = 0.63), malignancy (P = 1.0), CLD (P = 0.097), and thyroid disorder (P = 0.85) among the groups. Using SPPBT, frailty was found to be significantly higher in CKD patients in comparison to control (78% vs. 62%, P = 0.014). Using the HGS criteria, frailty was detected almost similar in both the groups (CKD vs. non-CKD; 77% vs. 78%, P = 0.866). Frailty was found to be high (78.5%) in CKD patients who had estimated glomerular filtration rate of

P0912THE SERUM CREATININE TO CYSTATIN C RATIO AND CLINICAL OUTCOMES IN PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE: THE KNOW-CKD COHORT

Abstract Background and Aims Muscle wasting leads to poor outcomes in patient with chronic kidney disease (CKD). The serum creatinine to cystatin C (Cr/CysC) ratio has been reported as marker for muscle mass and may predict outcomes in chronic diseases. We hypothesized that the Cr/CysC ratio would be a predictor of outcomes in CKD. Method We investigated a total of 2142 patients (male 61%, aged 54±12 year) with CKD followed for a median of 3.74 years. We assessed the factors associated with Cr/CysC ratio and the relationship between Cr/CysC ratio and outcomes of end-stage renal disease (ESRD), cardiovascular event (CVE), and mortality. Results The Cr/CysC ratio significantly correlated with age (r=-0.18), estimated glomerular filtration rate (eGFR) (r=-0.21), serum albumin (r=0.11), 24-hour urine creatinine (r=0.38), and moderate to vigorous physical activity time (r=0.07). After adjusting for age, sex, eGFR, and log urine albumin creatinine ratio (model 1), the hazard ratios for ESRD, CVE, and mortality were 0.96 (95% CI, 0.86-1.07), 0.78 (95% CI, 0.61-0.99), and 0.72 (95% CI, 0.53-0.97) per 1 standard deviation Cr/CysC increase (0.21), respectively. After full adjustment for model 1 variables plus lifestyle factors, laboratory factors, and comorbidities (model 2), the hazard ratios for ESRD, CVE, and mortality were 0.99 (95% CI, 0.88-1.10), 0.84 (95% CI, 0.65-1.07), and 0.75 (95% CI, 0.55-0.99) per 1 standard deviation Cr/CysC increase (0.24), respectively. In subgroup of the elderly (age&amp;gt;65 year) and early stage CKD (eGFR&amp;gt;60 ml/min/1.73m2), the hazard ratios for CVE were significantly lower in patients with high Cr/CysC ratio. Conclusion Cr/CysC ratio correlates with muscle biomarkers and physical activity. A higher Cr/CysC ratio is associated with low CVE and mortality, but not ESRD in CKD.

P6251Prognostic value of ACEi/ARBS in elderly patients with heart failure with reduced ejection fraction with and without chronic kidney disease

Abstract Introduction Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers therapy (ACEI/ARB) have shown to reduce mortality in patients with heart failure and reduced left ventricular ejection fraction (HFrEF). However, there is lack of information about the benefit of these drugs in patients with chronic kidney disease (CKD), and even less in elderly patients. Our aim is to compare the prognostic impact of ACE/ARB if CKD is present or not Methods From January 2008 to July 2014, we consecutively enlisted 802 patients aged &gt;75 years that had ejection fraction ≤35%. Clinical, echocardiographic and ECG data were taken from hospital records. Follow-up was made via telephone and hospital records as well. We analyzed the relationship between treatment with ACEi/ARBs (with different doses) and occurrence of mortality or MACE (major adverse cardiovascular events: composite of death from any cause or hospitalization for heart failure). Results From the total population 410 (51%) patients that had not CKD (glomerular filtration rate (GFR) &gt;60ml/min/1,73m2) and 390 (49%) patients had CKD (with GFR ≤60ml/min/1,73m2). We analyze the population according the presence or not of CKD. Both groups had similar characteristics except the age: 81.5±4.5 years vs. 82.6±4.1 (p&lt;0.05) and the percentage of use of ACEi/ARB 78.8% of the total vs 66.9% of the total (p&lt;0.05). The mean ejection fraction was 27.9±6.5% vs 28.12±6.5% (p&gt;0.05). The mean follow up was 33±22 vs 32±23 months (p&gt;0.05). In patients with no CKD 170 (42%) patients died and 239 (58%) patients had a MACE. In the CKD group 211 (54.1%)patients died and 257 (65.9%)patients had a major cardiovascular event. In the univariate analysis in both groups the use of ACEi/ARB reduced the mortality and the MACE. After a multivariate analysis ACEi/ARB appear to be beneficial in the CKD group (OR 0.71 [0.50–0.98]) but not in no CKD group Conclusions According to our data, treatment with ACEI/ARB in elderly patients HFrEF and CKD should be encouraged even more than in those without CKD.

Effects of HbA1c on the Development and Progression of Chronic Kidney Disease in Elderly and Middle-Aged Japanese: Iki Epidemiological Study of Atherosclerosis and Chronic Kidney Disease (ISSA-CKD).

Objective The revised Standards of Medical Care in Diabetes-2018 recommend a less-intensive HbA1c target for elderly individuals than for younger ones. This study aimed to investigate the development and progression of chronic kidney disease (CKD) according to HbA1c levels separately for elderly and middle-aged individuals in a general Japanese population. Methods This was a retrospective cohort study using health checkup data in Iki City, Japan. The participants of the study were 5,554 residents who attended health checkups more than 2 times over 8 years. This study consists of two sets of analyses to determine (1) the effects of HbA1c on the development of CKD among 4,570 subjects who did not have CKD at baseline and (2) the effects of HbA1c on the progression of CKD in 953 subjects with existing CKD at baseline. Results After adjusting for various risk factors, the multivariable-adjusted hazard ratios for development of CKD increased with the HbA1c level: 1.43 for 7-9% and 1.67 for >9% compared with the reference of <7% (p<0.306 for trend). Similar findings were also observed for the progression of CKD: hazard ratios of 2.48 for 7-9% and 2.46 for >9% compared with the reference of <7% (p<0.077 for trend). No significant differences in the effects of HbA1c level on the development or progression of CKD were observed between elderly and middle-aged individuals (p>0.3 for interaction). Conclusion The risks of the development and progression of CKD increased from HbA1c levels of 7% in a general Japanese population. Similar associations were observed for both elderly and middle-aged individuals.