Drug-Related Renal Dysfunction in the Elderly

Abstract Backgound: The clinical course of multiple myeloma is often associated with significant bone related morbidity. This can be modified by the use of bisphosphonates. Studies have shown renal toxicity associated with different bisphosphonates especially following the exposure of zoledronic acid. Published literature suggests renal function deterioration occurs in 8.8–15.2% of patients at recommended dose of 4 mg infused intravenously over 15 minutes. Methods: We retrospectively reviewed the records of all patients with multiple myeloma who received bisphosphonates during the period of January 2002-June 2004 at our institution. 114 patients were analyzed (male/female 63/51; age-median 69;mean 71;range 40–92). 61 (54%) were >70 years of age. They received a total of 1301 doses (mean 11.4) during this period. The type of bisphosphonate used was: zolendronate: 58; pamidronate: 23; pamidronate changed to zolendronate (both) : 33. Patients were categorized to the type and sequence of bisphosphonates [ pamidronate vs. zoledronate and pamidronate followed by zoledronate (both) ], age and sex. Renal dysfunction was defined as an increase in serum creatinine of >0.5 mg/dl over baseline. Results: There were 19 patients (16.7%) who developed renal dysfunction. 15 of the 19 episodes (79%) occurred in the 70 years and older group. The table shows the distribution of patients, type of bisphosphonate and the distribution of patients with renal toxicity. Conclusion: This analysis showed increase in renal dysfunction occurs in all ages with use of bisphosphonates. The elderly may be particularly susceptible to this toxicity. Although we have not analyzed the impact of associated comorbidities (including type of multiple myeloma) leading to renal insufficiency in this study, the elderly patients may need more close monitoring of renal function with the use of bisphosphonates. Age and renal impairment with bisphosphonate use Age Zolendronate Pamidronate Both Total Number in paranthesis indicates the renal impairment case 40–49 6 (0) 2 (0) 2 (0) 10 (0) 50–59 10 (0) 1 (0) 4 (0) 15 (0) 60–69 14 (2) 3 (0) 11 (1) 28(3) 70–79 19 (3) 9 (1) 14 (4) 42 (8) 80+ 9 (3) 8 (0) 2 (4) 19 (7) Total 58 (9) 23 (1) 33 (9) 114 (19)

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Transesophageal echocardiographic detection of aortic atheromatosis may provide clues to occult renal dysfunction in the elderly

American Heart Journal ◽

10.1016/0002-8703(92)90823-e ◽

1992 ◽

Vol 123 (6) ◽

pp. 1684-1686 ◽

Cited By ~ 23

Author(s):

Kevin M. Coy ◽

Gerald Maurer ◽

David Goodman ◽

Robert J. Siegel

Keyword(s):

Renal Dysfunction ◽

The Elderly

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New Study Links Chronic Renal Dysfunction and Proteinuria with a Risk of Parkinson's Disease in the Elderly

Neurology Today ◽

10.1097/01.nt.0000576900.29063.b3 ◽

2019 ◽

Vol 19 (13) ◽

pp. 23-24

Author(s):

Susan Kreimer

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Renal Dysfunction ◽

The Elderly

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Darkness at the End of the Tunnel: Poststenotic Kidney Injury

Physiology ◽

10.1152/physiol.00010.2013 ◽

2013 ◽

Vol 28 (4) ◽

pp. 245-253 ◽

Cited By ~ 9

Author(s):

Alfonso Eirin ◽

Lilach O. Lerman

Keyword(s):

Renal Failure ◽

Renal Artery ◽

Renal Dysfunction ◽

Disease Progression ◽

Renal Artery Stenosis ◽

Renal Injury ◽

Elderly Population ◽

Kidney Injury ◽

The Elderly ◽

Current Understanding

Renal artery stenosis remains an important contributor to renal failure in the elderly population, but uncertainty continues to surround the mechanisms underlying progressive renal dysfunction. Here, we present the current understanding of the pathogenic mechanisms responsible for renal injury in these patients, with emphasis on those involved in disease progression.

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3. Antimicrobial Therapy for the Elderly and Patients with Renal Dysfunction.

Nihon Naika Gakkai Zasshi ◽

10.2169/naika.100.3551 ◽

2011 ◽

Vol 100 (12) ◽

pp. 3551-3556 ◽

Cited By ~ 1

Author(s):

Futoshi Higa

Keyword(s):

Renal Dysfunction ◽

Antimicrobial Therapy ◽

The Elderly

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Prevalence of renal dysfunction and its influence on functional capacity in elderly patients with stable chronic heart failure

Vojnosanitetski pregled ◽

10.2298/vsp1210840s ◽

2012 ◽

Vol 69 (10) ◽

pp. 840-845 ◽

Cited By ~ 2

Author(s):

Dragana Stanojevic ◽

Svetlana Apostolovic ◽

Ruzica Jankovic-Tomasevic ◽

Sonja Salinger-Martinovic ◽

Milan Pavlovic ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Renal Dysfunction ◽

Functional Capacity ◽

Exercise Tolerance ◽

Nyha Class ◽

The Elderly ◽

Left Ventricular ◽

Walking Distance ◽

Left Ventricular Ejection

Bacground/Aim. Chronic heart failure (CHF) is highly prevalent and constitutes an important public health problem around the world. In spite of a large number of pharmacological agents that successfully decrease mortality in CHF, the effects on exercise tolerance and quality of life are modest. Renal dysfunction is extremely common in patients with CHF and it is strongly related not only to increased mortality and morbidity but to a significant decrease in exercise tolerance, as well. The aim of our study was to investigate the prevalence and influence of the renal dysfunction on functional capacity in the elderly CHF patients. Methods. We included 127 patients aged over 65 years in a stable phase of CHF. The diagnosis of heart failure was based on the latest diagnostic principles of the European Society of Cardiology. The estimated glomerular filtration rate (eGRF) was determined by the abbreviated Modification of Diet in Renal Disease (MDRD2) formula, and patients were categorized using the Kidney Disease Outcomes Quality Initiative (K/DOQI) classification system. Functional capacity was determined by the 6 minute walking test (6MWT). Results. Among 127 patients, 90 were men. The average age was 72.5 ? 4.99 years and left ventricular ejection fraction (LVEF) was 40.22 ? 9.89%. The average duration of CHF was 3.79 ? 4.84 years. Ninty three (73.2%) patients were in New York Heart Association (NYHA) class II and 34 (26.8%) in NYHA class III. Normal renal function (eGFR ? 90 mL/min) had 8.9% of participants, 57.8% had eGFR between 60-89 mL/min (stage 2 or mild reduction in GFR according to K/DOQI classification), 32.2% had eGFR between 30-59 mL/min (stage 3 or moderate reduction in GFR) and 1.1% had eGFR between 15-29 mL/min (stage 4 or severe reduction in GFR). We found statistically significant correlation between eGFR and 6 minute walking distance (6MWD) (r = 0.390, p < 0.001), LVEF (r = 0.268, p < 0.05), NYHA class (? = -0.269, p < 0.05) and age (r = - 0.214, p < 0.05). In multiple regression analysis only patients? age was a predictor of decreased 6MWD < 300 m (OR = 0.8736, CI = 0.7804 - 0.9781, p < 0.05). Conclusion. Renal dysfunction is highly prevalent in the elderly CHF patients. It is associated with decreased functional capacity and therefore with poor prognosis. This study corroborates the use of eGFR not only as a powerful predictor of mortality in CHF, but also as an indicator of the functional capacity of cardiopulmonary system. However, clinicians underestimate a serial measurement of eGFR while it should be the part of a routine evaluation performed in every patient with CHF, particularly in the elderly population.

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Chronic renal dysfunction, proteinuria, and risk of Parkinson's disease in the elderly

Movement Disorders ◽

10.1002/mds.27704 ◽

2019 ◽

Vol 34 (8) ◽

pp. 1184-1191 ◽

Cited By ~ 14

Author(s):

Ga Eun Nam ◽

Nan Hee Kim ◽

Kyungdo Han ◽

Kyung Mook Choi ◽

Hye Soo Chung ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Renal Dysfunction ◽

The Elderly

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P0798ASSOCIATION BETWEEN RENAL DYSFUNCTION AND GENERAL COGNITIVE FUNCTION IN COMMUNITY DWELLING OLDER ADULTS: KOREAN FRAILTY AND AGING COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0798 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Jiyoon Kong ◽

Jin Sug Kim ◽

Min Hye Kang ◽

Shin Yeong Kang ◽

Ri Ra ◽

...

Keyword(s):

Older Adults ◽

Renal Function ◽

Cohort Study ◽

Cognitive Impairment ◽

Cognitive Function ◽

Renal Dysfunction ◽

The Elderly ◽

Community Dwelling ◽

Community Dwelling Older Adults ◽

The Relationship

Abstract Background and Aims Cognitive impairment is common in older adults. Similarly, the prevalence of renal dysfunction is also increased in the elderly. We conducted this study to clarify the relationship between the renal function and cognitive impairment in community dwelling older adults in Korea. Method A cross-sectional analysis was performed on the data of the Korean Frailty and Aging Cohort Study (KFACS), a nationwide cohort study that began in 2016. Of the 3014 participants assessed in the first and second year, 2847 participants (1333 men, 1514 women) who completed baseline assessments were enrolled. The estimated glomerular filtration rate (eGFR, mL/min/1.73m2) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Renal function of the participants was classified into four groups by eGFR quartile. General cognitive function was accessed with mini-mental state exam in the Korean version (MMSE-KC). Participants who had MMSE-KC score less than 1.5 standard deviation by age, gender, and education level were regarded as the cognitive impairment. Multivariate logistic regression model was used to examine the relationship between renal function and cognitive impairment. In addition, we investigated to find the point of eGFR interval at which the odds ratio begins to increase. Results The mean eGFR in quartile 1 was 91.7 ± 3.22 ml/min/1.73m2, and 84.9 ± 1.81 in quartile 2, 76.1 ± 3.66 in quartile 3, and 57.2 ± 10.75 in quartile 4. In baseline characteristics, participants with lower eGFR had lower MMSE-KC scores. And the prevalence of cognitive impairment was 10.8% in quartile 1, 15.9% in quartile 2, 15.2% in quartile 3, 14.9% in quartile 4. After multivariate adjustment, the odds ratio (OR) of cognitive impairment in quartile 2 [adjusted OR: 1.569, 95% confidence intervals (CI): 1.141 - 2.158, p = 0.006] compared with quartile 1. And the odd ratios of cognitive impairment were 1.539 (95% CI: 1.113 - 2.127, p = 0.009) in quartile 3, 1.475 (95% CI: 1.062 - 2.049, p = 0.020) in quartile 4 compared with quartile 1, respectively. Among the participants with eGFR above 60 ml/min/1.73m2, the renal function was grouped by 5 ml/min/1.73m2 interval. The risk of cognitive impairment started to increase from eGFR between 80 and 85 ml/min/1.73m2 (adjusted OR: 1.667, 95% CI: 1.128 - 2.463, p = 0.010). Conclusion Renal dysfunction was associated with lower global cognitive function in older adults. And the risk of cognitive impairment increased from quartile 2, especially, eGFR between 80 and 85 ml/min/1.73m2 in this population. These results suggest that mild decline of kidney function is also a risk factor of cognitive decline in the elderly.

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