Current issue
Journal content
Articles in press
Archive
About the Journal
About the Polish Annals of Medicine
Editorial Board
Open Access policy
Abstracting & indexing
Affiliated institutions
Contact
Instructions
Guide for authors
Peer review process
Publication ethics
Ethics and Patient Consent
User License
Usage of third party materials
Disclaimer
Reviewers
Guide for reviewers
List of reviewers
Review Form
RESEARCH PAPER
Chronic kidney disease in elderly – Fact or fiction?
| 1 | ols-Med General Practice, Bartoszyce, Poland |
| 2 | Department of Nephrology, Hypertension and Internal Medicine, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland |
| 3 | Department of Cardiology and Cardiac Surgery, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland |
CORRESPONDING AUTHOR
Tomasz Stompór
Department of Nephrology, Hypertension and Internal Medicine, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Żołnierska 18, 10-561 Olsztyn, Poland. Tel.: +48 89 5386219; fax: +48 89 5337882.
Department of Nephrology, Hypertension and Internal Medicine, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Żołnierska 18, 10-561 Olsztyn, Poland. Tel.: +48 89 5386219; fax: +48 89 5337882.
Submission date: 2014-02-11
Acceptance date: 2014-07-17
Online publication date: 2014-04-15
Publication date: 2020-04-06
Pol. Ann. Med. 2014;21(2):90–95
KEYWORDS
ABSTRACT
Introduction:
Chronic kidney disease (CKD) affects up to 10% of modern societies and its prevalence increases with age. In most epidemiological reports CKD is diagnosed based mainly or exclusively on estimated glomerular filtration rate (eGFR) assessment. Since no ‘‘gold standard’’ or reference method of eGFR calculation exists and other diagnostic criteria of CKD are rarely employed, the true prevalence of clinically significant CKD seems to be lower than reported in large epidemiological studies.
Aim:
We aimed to analyze the prevalence of CKD and its clinical significance in the cohort of patients aged 65 years and older in general practice, applying all recommended criteria.
Material and methods:
108 consecutive patients (40 men and 68 women) aged 65 years and older (mean age 72 ± 5.2 years; range 65–87 years) were analyzed. Biochemical tests available in general practice with eGFR calculation using modification of diet in renal disease (MDRD), CKD epidemiology collaboration (CKD-EPI), Cockcroft–Gault formula and renal ultrasound were performed.
Results and discussion:
50% of patients were characterized with significantly reduced MDRD/CKD-EPI-eGFR (<60 mL/min/1.73 m2). Detailed analysis revealed that patients with low eGFR do not differ from those with eGFR more than or equal to 60 mL/min/1.73 m2 in terms of serum biochemical parameters (except for urea and creatinine), proteinuria/albuminuria, urinalysis, renal ultrasound, blood pressure or history of cardiovascular disease.
Conclusions:
Stage 3 CKD (eGFR < 60 mL/min/1.73 m2) in patients aged 65 years or older seems to be a ‘‘benign’’ finding with no important clinical consequences. It should be emphasized that these results apply to ambulant elderly patients with relatively low co-morbidities.
Chronic kidney disease (CKD) affects up to 10% of modern societies and its prevalence increases with age. In most epidemiological reports CKD is diagnosed based mainly or exclusively on estimated glomerular filtration rate (eGFR) assessment. Since no ‘‘gold standard’’ or reference method of eGFR calculation exists and other diagnostic criteria of CKD are rarely employed, the true prevalence of clinically significant CKD seems to be lower than reported in large epidemiological studies.
Aim:
We aimed to analyze the prevalence of CKD and its clinical significance in the cohort of patients aged 65 years and older in general practice, applying all recommended criteria.
Material and methods:
108 consecutive patients (40 men and 68 women) aged 65 years and older (mean age 72 ± 5.2 years; range 65–87 years) were analyzed. Biochemical tests available in general practice with eGFR calculation using modification of diet in renal disease (MDRD), CKD epidemiology collaboration (CKD-EPI), Cockcroft–Gault formula and renal ultrasound were performed.
Results and discussion:
50% of patients were characterized with significantly reduced MDRD/CKD-EPI-eGFR (<60 mL/min/1.73 m2). Detailed analysis revealed that patients with low eGFR do not differ from those with eGFR more than or equal to 60 mL/min/1.73 m2 in terms of serum biochemical parameters (except for urea and creatinine), proteinuria/albuminuria, urinalysis, renal ultrasound, blood pressure or history of cardiovascular disease.
Conclusions:
Stage 3 CKD (eGFR < 60 mL/min/1.73 m2) in patients aged 65 years or older seems to be a ‘‘benign’’ finding with no important clinical consequences. It should be emphasized that these results apply to ambulant elderly patients with relatively low co-morbidities.
CONFLICT OF INTEREST
None declared.
REFERENCES (24)
1.
Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089–2100.
2.
Mazza A, Montemurro D, Piccoli A, et al. Comparison of methods for determination of glomerular filtration rate in hypertensive subjects with normal serum creatinine. Blood Press. 2010;19(5):278–286.
3.
O'Hare AM, Bertenthal D, Covinsky KE, et al. Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol. 2006;17(3):846–853.
4.
Esposito C, Torregiani M, Arrazi M, et al. Loss of renal function in the elderly Italians: a physiologic or pathologic process? Gerontol A Biol Sci Med Sci. 2012;67(12):1387–1393.
5.
Glassock RJ, Winearls C. An epidemic of chronic kidney disease: fact or fiction? Nephrol Dial Transplant. 2008;23(4):1117–1121.
6.
Douville P, Martel AR, Talbot J, Desmeules S, Langlosi S, Agharazii M. Impact of age on glomerular filtration estimates. Nephrol Dial Transplant. 2009;24(1):97–103.
7.
Barton M. Ageing as a determinant of renal and vascular disease: role of endothelial factors. Nephrol Dial Transplant. 2005;20(3):485–490.
8.
Nygaard HA, Naik M, Ruths S, Krüger K. Clinically important renal impairment in various groups of old persons. Scand J Prim Health Care. 2004;22(3):152–156.
9.
Prigent A. Monitoring renal function and limitations of renal function tests. Semin Nucl Med. 2008;38(1):32–46.
10.
Matsushita K, Mahmoodi BK, Woodward M, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. Chronic Kidney Disease Prognosis Consortium. JAMA. 2012;307(18):1941–1951.
11.
Chudek J, Wieczorowska-Tobis K, Zejda J, Węgrowicz- Rebandel I, Zdrojewski T, Więcek A. Częstość występowania przewlekłej choroby nerek u osób w wieku podeszłym w Polsce. In: Mossakowska A, Więcek A, Błędowski P, eds. In: PolSenior. Aspekty medyczne, psychologiczne, socjologiczne i ekonomiczne starzenia się ludzi w Polsce. Poznań: Termedia; 2012:223–236 [in Polish].
12.
Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–613.
13.
Roderick PJ, Atkins R, Smeeth L, et al. Detecting chronic kidney disease in older people: what are the implications? Age Ageing. 2008;37(2):179–186.
14.
Wetzels JFM, Kiemeney LA, Swinkels DW, Willems HL, De Heijen M. Age- and gender-specific reference values of estimated GFR in Caucasians: the Nijmegen Biomedical Study. Kidney Int. 2007;72(2):632–637.
15.
Bowling CB, Inker LA, Gutiérrez OM, et al. Age-specific associations of reduced estimated glomerular filtration rate with concurrent chronic kidney disease complications. Clin J Am Soc Nephrol. 2011;6(12):2822–2828.
16.
Danziger J. Importance of low-grade albuminuria. Mayo Clin Proc. 2008;83(7):806–812.
17.
MacIsaac RJ, Tsalamandris C, Panagiotopoulos S, Smith TJ, McNeil KJ, Jerums G. Nonalbuminuric renal insufficiency in type 2 diabetes. Diabetes Care. 2004;27(1):195–200.
18.
Hallan S, Astor B, Romundstad S, et al. Association of kidney function and albuminuria with cardiovascular mortality in older versus younger individuals. Arch Intern Med. 2007;167(8):2490–2496.
19.
Hillege HL, Fidler V, Diercks GF, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation. 2002;106(14):1777–1782.
20.
Lieb W, Mayer B, Stritzke J, et al. Association of low-grade urinary albumin excretion with left ventricular hypertrophy in the general population: the MONICA/KORA Augsburg Echocardiographic Substudy. Nephrol Dial Transplant. 2006;21(10):2780–2787.
21.
Emamian SA, Nielsen MB, Pedersen JF. Kidney dimensions at sonography: correlation with age, sex, and habitus in 665 adult volunteers. Br J Roentgenol. 1993;160(787):83–86.
22.
Kaplon MD, Lasser MS, Sigman D, Haleblian GE, Pareek G. Renal parenchyma thickness: a rapid estimation of renal function on computed tomography. Int Braz J Urol. 2009;35(1):3–8.
23.
Caglioti A, Esposito C, Fuiano G, Buzio C. Prevalence of symptoms in patients with simple renal cysts. Br Med J. 1993;306(6875):430–431.
24.
Wheeler DC, Becker GJ. Summary of KDIGO guideline. What do we really know about management of blood pressure in patients with chronic kidney disease? Kidney Int. 2013;83(3):377–383.
RELATED ARTICLE
