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Abstract: FR-PO879

Large Discordances Between Creatinine (Cr) and Cystatin C-Based Estimated Glomerular Filtration Rates (eGFR) Are Associated with Adverse Outcomes in a Nationally Representative Cohort of Older Adults

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Katz, Nurit S., Mass General Brigham Inc, Boston, Massachusetts, United States
  • Rieu-Werden, Meghan L., Mass General Brigham Inc, Boston, Massachusetts, United States
  • Shah, Sachin J., Mass General Brigham Inc, Boston, Massachusetts, United States
  • Sise, Meghan E., Mass General Brigham Inc, Boston, Massachusetts, United States
Background

Creatinine based eGFR may be overestimated in adults with sarcopenia. While the combined equation CKD-EPI eGFR-CRE-CYS may be more accurate on a population level, patients whose eGFR-CYS is significantly lower than eGFR-CRE (eGFR discordance) may be at high risk for adverse outcomes.

Methods

In a longitudinal cohort study of adults 65+ yrs, from the Health and Retirement Study 2016 Venous Blood Study, we calculated eGFR-CRE and eGFR-CYS with current CKD-EPI. Outcomes included fall, hip fracture, hospitalization, and death 2 years from baseline assessment. We plotted the relationship between eGFR discordance and likelihood of outcomes in each ventile using a loess plot with span 75%. We fit separate multivariable logistic regression to determine the association between large eGFR discordances (i.e. >30%) and each outcome, adjusted for confounders.

Results

There were 5574 participants with a mean age of 75 ±7.2 yrs, 58% women, 80% white, and 10% Hispanic. 35% had chronic kidney disease (CKD) (eGFR-CRE-CYS <60 ml/min/1.73m2). 30% had eGFR-CYS >30% lower than eGFR-CRE. We found increasing rates of falls, hospitalizations, and death at higher eGFR discordances [Figure 1]. In adjusted analyses, large eGFR discordance was associated with a significantly greater odd of fall , hospitalization , and death [Figure 2].

Conclusion

Older adults with a large eGFR discordances have a greater risk of adverse outcomes, possibly due to misdosing of renally cleared medications, occult CKD or sarcopenia.