Kidney Week

Abstract: TH-PO785

Older Patients Are Less Prone to Fast Decline of Renal Function: A Propensity-Matched Study

Session Information

• Voices, Choices, and Outcomes of Older Adults with CKD
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

• 1200 Geriatric Nephrology

Authors

• Pina, Paula Mionete ribeiro, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil

Paula Mionete ribeiro Pina,

• Arcon, Luis Carlos, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil

Luis Carlos Arcon,

• Zatz, Roberto, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil

Roberto Zatz,

• Moyses, Rosa M.A., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil

Rosa M.A. Moyses,

• Elias, Rosilene M., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil

Rosilene M. Elias,

Background

Although Chronic Kidney Disease (CKD) is common among aging patients, and although factors associated with its progression have been studied over decades, little is known about the rate of renal functional decay in this population.

Methods

Between January 2012 and December 2017, we included 1071 adult CKD patients on conservative treatment in a 1:1 propensity-score matched study of older (O, >65yr) and younger (Y, ≤65yr) individuals. Factors associated with the slope of the decline of eGFR (S), such as proteinuria, initial eGFR, diabetes, sex, and use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) were analyzed. Inclusion criteria were at least two consultations in the service, and an initial eGFR lower than 45 ml/min/m². Patients were classified as fast progressors when S exceeded 5 ml/min/1.73 m²/yr).

Results

Crude analysis of eGFR decline showed slower progression of O when compared to Y, both in terms of absolute change [-2.0 (-4.5, -1.0) vs. -3.0 (-7.0, -1.0) ml/min/1.73m², p <0.001] and of S [-2.2 (-4.4, -1.0) vs. -3.1 (-6.7, -1.2)) ml/min/1.73m², p <0.001]. Patients considered fast progressors were less likely to be older (35.2% younger vs. 22.0% older, p<0.001). Accordingly, adjusted logistic multivariate regression revealed that the odds ratio of fast eGFR decline was lower in O than in Y (p=0.0001), independently of proteinuria (p=0.063), diabetes (p=0.017), ACEI/ARB use (p=0.0001), sex (p=0.0001), or baseline values for eGFR (p=0.001), phosphate (p=0.0001) and 25(OH) vitamin D (p=0.0001). The reasons for these differences between O and Y are unclear.

Conclusion

In patients over 65 years of age, CKD progression was slower than in younger patients even after multiple adjustments. This finding should be taken into consideration during both conservative management and preparation for dialysis.

Odds ratio of fast progressor of renal function decline, defined as a reduction above 5 ml/min/1.73m²/year

Funding

• Government Support – Non-U.S.