Overdiagnosis of Chronic Kidney Disease in Older Adults—An Inconvenient Truth

2021 ◽  
Vol 181 (10) ◽  
pp. 1366
Author(s):  
Ann M. O’Hare ◽  
Rudolph A. Rodriguez ◽  
Andrew D. Rule
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
An Inconvenient Truth

scholarly journals Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy

2021 ◽  
Vol 18 (8) ◽  
pp. 4370
Author(s):  
A Kim ◽  
Hayeon Lee ◽  
Eun-Jeong Shin ◽  
Eun-Jung Cho ◽  
Yoon-Sook Cho ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medication Management ◽  
Medication Use ◽  
Potentially Inappropriate Medications ◽  
Management Service ◽  
Ckd Stage ◽  
The Impact

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.

scholarly journals Everyday Discrimination and Kidney Function Among Older Adults: Evidence From the Health and Retirement Study

2019 ◽  
Vol 75 (3) ◽  
pp. 517-521
Author(s):  
Ryon J Cobb ◽  
Roland J Thorpe ◽  
Keith C Norris
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
The United States ◽  
Health And Retirement Study ◽  
Disease Epidemiology ◽  
Lower Egfr ◽  
Everyday Discrimination ◽  
Retirement Study

Abstract Background With advancing age, there is an increase in the time of and number of experiences with psychosocial stressors that may lead to the initiation and/or progression of chronic kidney disease (CKD). Our study tests whether one type of experience, everyday discrimination, predicts kidney function among middle and older adults. Methods The data were from 10 973 respondents (ages 52–100) in the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative survey of older adults in the United States. Estimated glomerular filtration rate (eGFR) derives from the Chronic Kidney Disease Epidemiology Collaboration equation. Our indicator of everyday discrimination is drawn from self-reports from respondents. Ordinary Least Squared regression (OLS) models with robust standard errors are applied to test hypotheses regarding the link between everyday discrimination and kidney function. Results Everyday discrimination was associated with poorer kidney function among respondents in our study. Respondents with higher everyday discrimination scores had lower eGFR after adjusting for demographic characteristics (B = −1.35, p &lt; .05), and while attenuated, remained significant (B = −0.79, p &lt; .05) after further adjustments for clinical, health behavior, and socioeconomic covariates. Conclusions Our study suggests everyday discrimination is independently associated with lower eGFR. These findings highlight the importance of psychosocial factors in predicting insufficiency in kidney function among middle-aged and older adults.

Nonprogressive Kidney Dysfunction and Outcomes in Older Adults with Chronic Kidney Disease

2009 ◽  
Vol 57 (12) ◽  
pp. 2217-2223 ◽  
Author(s):  
Balsam El-Ghoul ◽  
Caroline Elie ◽  
Tarek Sqalli ◽  
Paul Jungers ◽  
Michel Daudon ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Dysfunction

scholarly journals Trajectory of Estimated Glomerular Filtration Rate and Malnourishment Predict Mortality and Kidney Failure in Older Adults With Chronic Kidney Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Shuo-Chun Weng ◽  
Chyong-Mei Chen ◽  
Yu-Chi Chen ◽  
Ming-Ju Wu ◽  
Der-Cherng Tarng
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Kidney Failure ◽  
Quadratic Term ◽  
Mixed Effect ◽  
Risk Of Death ◽  
Nutritional Risk Index ◽  
Prospective Longitudinal

Objective: The trajectory patterns of estimated glomerular filtration rates (eGFR) in chronic kidney disease (CKD) older adults with malnourishment and their association with subsequent patient outcomes have not been elucidated. We aimed to assess the eGFR trajectory patterns for predicting patient survival and kidney failure in the elderly without or with malnourishment.Materials and Methods: Based on a prospective longitudinal cohort, CKD patients aged 65 years or older were enrolled from 2001 to 2013. Among the 3,948 patients whose eGFR trajectory patterns were analyzed, 1,872 patients were stratified by the absence or presence of malnourishment, and 765 patients were identified and categorized as having malnourishment. Four eGFR trajectory patterns [gradual decline (T0), early non-decline and then persistent decline (T1), persistent increase (T2), and low baseline and then progressive increase (T3)] were classified by utilizing a linear mixed-effect model with a quadratic term in time. The malnourishment was defined as body mass index &lt; 22 kg/m2, serum albumin &lt; 3.0 mg/dL, or Geriatric Nutritional Risk Index (GNRI) &lt; 98. This study assessed the effectiveness of eGFR trajectory patterns in a median follow-up of 2.27 years for predicting all-cause mortality and kidney failure.Results: The mean age was 76.9 ± 6.7 years, and a total of 82 (10.7%) patients with malnourishment and 57 (5.1%) patients without malnourishment died at the end of the study. Compared with the reference trajectory T0, the overall mortality of T1 was markedly reduced [adjusted hazard ratio (aHR) = 0.52, 95% confidence interval (CI) 0.32–0.83]. In patients with trajectory, T3 was associated with a high risk for kidney failure (aHR = 5.68, 95% CI 3.12–10.4) compared with the reference, especially higher risk in the presence of malnourishment. Patients with high GNRI values were significantly associated with a lower risk of death and kidney failure, but patients with malnourishment and concomitant alcohol consumption had a higher risk of kidney failure.Conclusions: Low baseline eGFR and progressively increasing eGFR trajectory were high risks for kidney failure in CKD patients. These findings may be attributed to multimorbidity, malnourishment, and decompensation of renal function.

Management of acute kidney injury and chronic kidney disease

2017 ◽  
pp. 1087-1096
Author(s):  
Natalie Ebert ◽  
Elke Schaeffner
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Staging System ◽  
Kidney Damage ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Both acute and chronic states of kidney disease have considerable healthcare impact as they can produce enormous disease burden and costs. To classify chronic kidney disease into the CKD staging system, glomerular filtration rate as an index of kidney function, as well as albuminuria as a marker of kidney damage have to be assessed as correctly as possible. Misclassification is a serious concern due to the difficulties in precise GFR assessment and correct interpretation of results. Differentiating between pure senescence and true disease among older adults can be a delicate issue. To find the right renal replacement option for individuals that progress to end-stage renal disease can be challenging, and some older patients may even benefit from conservative care without dialysis. To prevent acute kidney injury as a frequent and potentially life-threatening complication, clinicians need to develop an understanding of the common vulnerability to kidney damage among older adults.

scholarly journals Opioid Management in Older Adults with Chronic Kidney Disease: A Review

2019 ◽  
Vol 132 (12) ◽  
pp. 1386-1393 ◽  
Author(s):  
Montgomery T. Owsiany ◽  
Chelsea E. Hawley ◽  
Laura K. Triantafylidis ◽  
Julie M. Paik
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease

scholarly journals Relationships of Fat and Muscle Mass with Chronic Kidney Disease in Older Adults: A Cross-Sectional Pilot Study

2020 ◽  
Vol 17 (23) ◽  
pp. 9124
Author(s):  
Bokun Kim ◽  
Hyuntae Park ◽  
Gwonmin Kim ◽  
Tomonori Isobe ◽  
Takeji Sakae ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Estimated Glomerular Filtration Rate ◽  
Fat Free Mass ◽  
Creatinine Concentration ◽  
Cross Sectional ◽  
Assess Body Composition

This cross-sectional pilot study aimed to assess the relationships of fat and muscle mass with chronic kidney disease (CKD) in older adults. Serum creatinine concentration was used to measure estimated glomerular filtration rate (mL/min/1.73 m2) in the 236 subjects, who were allocated to three groups: a normal (≥60.0), a mild CKD (45.0–59.9), and a moderate to severe CKD (<45.0) group. The Jonckheere-Terpstra test and multivariate logistic regression were employed to assess body composition trends and the relationships of % fat mass (FM) or % muscle mass index (MMI) with moderate-to-severe CKD. Body weight, fat-free mass, MMI, and %MMI tended to decrease with an increase in the severity of CKD, but the opposite trend was identified for %FM. No relationship with BMI was identified. The participants in the middle-high and highest quartile for %FM were 6.55 and 14.31 times more likely to have moderate to severe CKD. Conversely, the participants in the highest quartile for %MMI were 0.07 times less likely to have moderate to severe CKD. Thus, high fat and low muscle mass may be more strongly associated with CKD than obesity per se.

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