Abstract: FR-PO933
Progression of CKD4 to CKD5/ESRD versus Death in the Very Elderly and Factors Associated with Survival
Session Information
- Geriatric Nephrology
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Geriatric Nephrology
- 901 Geriatric Nephrology
Authors
- Xue, Hui, Kaiser Permanente Southern California, San Diego, California, United States
- Henry, Shayna L., Kaiser Permanente Southern California, San Diego, California, United States
- Chen, Qiaoling, Kaiser Permanente Southern California, San Diego, California, United States
- Rutkowski, Mark P., Kaiser Permanente Southern California, San Diego, California, United States
- Mihara, Nichole, Kaiser Permanente Southern California, San Diego, California, United States
- Chang, Mi, Kaiser Permanente Southern California, San Diego, California, United States
Background
Geriatrics is the fastest growing population with End Stage Renal Disease (ESRD), and there is limited knowledge of transition from CKD4 to CKD5/ESRD vs death in this group. This study aims to shed light on the rate of progression from CKD stage 4 to CKD stage 5 or ESRD vs death, and the factors associated with survival in patients with eGFR≤20 and >75yrs old.
Methods
From 2003 to 2008, 1,431 adults, mean age 81.1±4.7yrs (range 75-99), with 15< eGFR ≤ 20 for at least 3 consecutive months RRT, were followed for 5 years with censoring at Dec 31, 2013. Subjects were followed until death vs eGFR≤15/dialysis, and those who maintained eGFR> 15 were censored at 5yrs. Survival of those who transitioned to CKD5/ESRD were separated into conservative care vs. Renal Replacement Therapy (RRT) groups and followed until death vs censoring at 5yrs. Multivariable hazard ratios were calculated for survival for the study population.
Results
Among older adults with CKD4, 930 (65%) reached CKD5/ESRD first, while 432 (30.2%) reached death first, and 69 (4.8%) maintained CKD4 and were censored at 5yrs. Most individuals reached CKD5/ESRD before death up till age 90. Among the 930 individuals who transitioned to CKD5/ESRD, 214 received conservative care and 716 received RRT. In the conservative management group, 140/214 (65.4%) died, vs in the RRT group 467/716 (65.2%) died. Median survival was 46 and 37 months for RRT and no RRT groups, respectively, and not statistically different (p=0.314). Age was the greatest factor associated with death, followed by medical comorbidities except hyperlipidemia. Asian race, statin, phosphate binder, and ACEi/ARB use offered survival advantages.
Conclusion
Among >75yrs old CKD4 patients, the risk of progression CKD5/ESRD is still higher than death up to age 90. Factors associated with improved survival, statin, phosphorous binders, ACEi/ARB, use, hyperlipidemia, and Asian race, warrant closer evaluation in future studies.
Funding
- Clinical Revenue Support