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The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: A secondary analysis of a multicentre cohort study
Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy.
Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy.
Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Stockholm.ORCID iD: 0000-0002-6933-4637
Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden.
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2022 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 51, no 7, article id afac168Article in journal (Refereed) Published
Abstract [en]

Background: age-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people. Methods: our series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index. Results: overall, mortality was found to increase starting from eGFR = 30-44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81-5.95) to ACR = 30-300 mg/g (HR = 1.96, 95%CI = 1.23-3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45-59.9 ml/min/1.73 m2, as well as patients with ACR < 30 mg/g and impaired handgrip and SPPB. Survival tree leaf node membership had greater predictive accuracy (C-index = 0.81, 95%CI = 0.78-0.84 for the eGFR survival tree and C-index = 0.77, 95%CI = 0.71-0.81 for the ACR survival tree) in comparison with that of individual measures of kidney function. Conclusions: physical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild-moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function. © 2022 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.

Place, publisher, year, edition, pages
Oxford University Press , 2022. Vol. 51, no 7, article id afac168
Keywords [en]
Activities of Daily Living, Aged, Albuminuria, Cohort Studies, Geriatric Assessment, Glomerular Filtration Rate, Hand Strength, Humans, Prospective Studies, Renal Insufficiency, Chronic, ADL disability, albumin to creatinine ratio, Article, chronic kidney failure, cognitive defect, estimated glomerular filtration rate, female, grip strength, human, major clinical study, male, malnutrition, mild renal impairment, moderate renal impairment, mortality rate, physical performance, prognosis, short physical performance battery, very elderly, clinical trial, cohort analysis, complication, daily life activity, glomerulus filtration rate, multicenter study, prospective study, ACR, disability, eGFR, mortality, older people
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:du-42179DOI: 10.1093/ageing/afac168ISI: 000829513300006PubMedID: 35871417Scopus ID: 2-s2.0-85135203094OAI: oai:DiVA.org:du-42179DiVA, id: diva2:1688247
Available from: 2022-08-18 Created: 2022-08-18 Last updated: 2023-09-22Bibliographically approved

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Ärnlöv, JohanRudholm Feldreich, Tobias

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