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Abstract: PO2387

Association of Kidney Measures with Cardiovascular Events, Kidney Outcomes, and Mortality Among Older Adults

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Turbay Caballero, Valentina, Universidad del Norte, Barranquilla, Atlantico, Colombia
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • Chen, Jinsong, University of Illinois at Chicago, Chicago, Illinois, United States
  • Iskander, Kirolos, University of Illinois at Chicago, Chicago, Illinois, United States
  • Aroca Martinez, Gustavo, Universidad Simon Bolivar, Barranquilla, Atlantico, Colombia
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
  • Musso, Carlos Guido, Hospital Italiano de Buenos Aires, Buenos Aires, Federal District, Argentina
Background

Based on current criteria (glomerular filtration rate [GFR] <60 ml/min/1.73m2 or urine albumin-to-creatinine ratio [UACR] ≥30 mg/g), the prevalence of CKD in U.S. older adults is up to 42% among those aged 65-79 years. However, the risk implications of this CKD definition in this population are controversial . We evaluated the risk of adverse outcomes among older adults across CKD stages based on the Kidney Disease Improving Global Outcomes (KDIGO) definition.

Methods

This study included 2640 older adults (age ≥75 years) without diabetes enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). We compared the risk of the primary composite SPRINT outcome, and all-cause death, across GFR and albuminuria categories based on KDIGO guidelines. To estimate GFR, we used the CKD Epidemiology Collaboration (CKD-EPI) equation and the Berlin Initiative Study (BIS1), a novel estimator of GFR in elderly persons.

Results

Mean age was 79.8 years, 37.9% were female, 17.0% of participants self-identified as non-Hispanic Black, 6.6% as Hispanic, and 74.6% as non-Hispanic White. Mean estimated GFR was 63.3 ml/min/1.73 m2, and median UACR 55 mg/g. In multivariable regression analysis, there was no statistically significant difference in the risk of the primary outcome among participants with UACR <30 mg/g, regardless of GFR level (Table). However, compared with participants with GFR ≥60 ml/min/1.73 m2 and UACR <30 mg/g, those with UACR ≥30 mg/g had higher risk of the primary outcome at all levels of GFR, with the highest risk observed among those with GFR <45 ml/min/1.73 m2. Similar results were observed with the BIS1 equation was used to estimate GFR.

Conclusion

Among older adults without diabetes, increased albuminuria was associated with adverse cardiovascular outcomes at all levels of GFR. However, low GFR was not associated with adverse outcomes in participants with normal albuminuria. These results support the proposal of an age-adapted definition of CKD.

Table

Funding

  • NIDDK Support