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Kidney Week

Abstract: PO1680

CKD in the Very Elderly: When Is It Only Aging?

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Reis, Marina, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
  • Gomes, Ana Marta, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
  • Fernandes, João Carlos, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
Background

Chronic kidney disease (CKD) diagnosis is increasingly common in the elderly and is associated with increased morbidity and mortality. As life expectancy increases, so does the prevalence of risk factors for CKD such as hypertension and diabetes. On the other hand, it is known that after 30 years, glomerular filtration rates decrease progressively, in a process called renal senescence. This study aims to identify risk factors for progressive CKD versus renal senescence in patients over 80 years.

Methods

We developed a single center retrospective study with 101 patients over 80 years followed by a nephrologist with CKD (estimated glomerular filtration rate (GFR) < 60 mL/min/ 1.73 m2) diagnosed for at least for 5 years. Progressive disease was defined as GFR decline greater than 5 mL/min/1.73 m2/year.

Results

Of 101 patients, 55.4% (n = 56) were male. Thirty eight percent presented CKD of undetermined etiology. Average GFR progression rate was 2.0 ± 4.4 ml/min/1.73m2 /year and in about 66% GFR decline rate was less than 5 ml / min / 1.73m2 . Regarding CKD complications, 37.6% had anemia and 18.7% needed erythropoiesis-stimulating agents. No patient was under phosphate binders and 4% needed vitamin D analogues. About 20.9% presented metabolic acidosis requiring supplementation. In the progressive CKD group, there was a higher prevalence of obesity (OR 4.1, p = 0.04) and metabolic acidosis (OR 6.1, p = 0.01). Nephrologist follow-up time was also statistically different between the groups (6.1 years in progressive CKD vs 4.1 years in non-progressive CKD, p = 0.04). In the multivariate analysis, only the presence of metabolic acidosis (1.07, 95% CI [1.1-7.5]) was associated with the development of progressive CKD.

Conclusion

In patients over 80 years, average rate of progression of CKD was 2.0 mL / min / 1.73 m2 / year, which, associated with the reduced life expectancy of patients in this age group, allows us to state that the vast majority will not reach CKD stage 5. According to this resuts, only patients with metabolic acidosis are at risk of developing progressive CKD. Nephrology consultation does not seem to have an impact on CKD progression, since the group with progressive disease had the longest follow-up.