Association of kidney function-related dietary pattern, weight status, and cardiovascular risk factors with severity of impaired kidney function in middle-aged and older adults with chronic kidney disease: a cross-sectional population study

Background and Objectives: The matricellular protein osteopontin is involved in the pathogenesis of both kidney and cardiovascular disease. However, whether circulating and urinary osteopontin levels are associated with the risk of these diseases is less studied. Design, Setting, Participants, and Measurements: A community-based cohort of elderly men (Uppsala Longitudinal Study of Adult Men [ULSAM]; n = 741; mean age: 77 years) was used to study the associations between plasma and urinary osteopontin, incident chronic kidney disease, and the risk of cardiovascular death during a median of 8 years of follow-up. Results: There was no significant cross-sectional correlation between plasma and urinary osteopontin (Spearman ρ = 0.07, p = 0.13). Higher urinary osteopontin, but not plasma osteopontin, was associated with incident chronic kidney disease in multivariable models adjusted for age, cardiovascular risk factors, baseline glomerular filtration rate, urinary albumin/creatinine ratio, and the inflammatory markers interleukin 6 and high-sensitivity C-reactive protein (odds ratio for 1 standard deviation [SD] of urinary osteopontin, 1.42, 95% CI 1.00-2.02, p = 0.048). Conversely, plasma osteopontin, but not urinary osteopontin, was independently associated with cardiovascular death (multivariable hazard ratio per SD increase, 1.35, 95% CI 1.14-1.58, p < 0.001, and 1.00, 95% CI 0.79-1.26, p = 0.99, respectively). The addition of plasma osteopontin to a model with established cardiovascular risk factors significantly increased the C-statistics for the prediction of cardiovascular death (p < 0.002). Conclusions: Higher urinary osteopontin specifically predicts incident chronic kidney disease, while plasma osteopontin specifically predicts cardiovascular death. Our data put forward osteopontin as an important factor in the detrimental interplay between the kidney and the cardiovascular system. The clinical implications, and why plasma and urinary osteopontin mirror different pathologies, remain to be established.

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Abstract P296: Age-related Differences in Risk Factors for Mortality Among Individuals with Chronic Kidney Disease: The REGARDS Study

Circulation ◽

10.1161/circ.129.suppl_1.p296 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Rikki M Tanner ◽

Barrett Bowling ◽

Monika M Safford ◽

Orlando Gutiérrez ◽

Lisandro D Colantonio ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Cardiovascular Risk Factors ◽

Older Individuals ◽

Increased Risk ◽

Regards Study

At younger ages, chronic kidney disease (CKD) is a progressive disorder associated with an increased risk for end-stage renal disease (ESRD). Older individuals with CKD are 10 to 20 times more likely to die than progress to ESRD. We hypothesized that, among individuals with CKD, the association between traditional cardiovascular risk factors with mortality would be weaker and the association between psychosocial risk factors with mortality would be stronger for individuals ≥ 75 years of age compared to those < 75 years of age. We included 5,924 REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants with CKD without ESRD at baseline. CKD was defined as an albumin-to-creatinine ratio ≥ 30 mg/g or an estimated glomerular filtration rate < 60 mL/min/1.73m2. The 12-item Short Form Health Survey (SF-12) was administered and low physical and mental component scores (PCS and MCS) were defined as scores in the lowest quintile. Mortality was assessed through biannual telephone follow-up and contact with proxies provided by the study participant upon recruitment. Date of death was confirmed through death certificates, National Death Index, or Social Security Death Index. Over a median follow-up of 5.0 years, 1,255 deaths occurred. The mortality rate was 30.9 (95% CI: 28.6 - 33.4) and 74.8 (95% CI: 69.2 - 80.8) per 1,000 person-years for individuals < 75 years and ≥ 75 years of age, respectively. Diabetes, history of stroke, and systolic blood pressure were associated with an increased risk for mortality among individuals < 75 years of age but not among those ≥ 75 years of age (Table 1). Low PCS was associated with a higher risk for mortality for both younger and older adults. Symptoms of depression and low MCS were not associated with mortality in either age group. In conclusion, some cardiovascular risk factors are associated with an increased risk for mortality among younger but not older individuals with CKD. These data suggest approaches to reduce mortality risk may differ for younger and older adults with CKD.

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MO187NON-STEROIDAL ANTI-INFLAMMATORY DRUG PRESCRIPTION IN THE YOUNG-OLD AND VERY- OLD: TYPE, ROUTE AND BURDEN OF CARDIOVASCULAR RISK FACTORS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.0065 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Cynthia Lim ◽

Jason Choo ◽

Jia Liang Kwek ◽

Hanis Abdul Kadir ◽

Ngiap Chuan Tan

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Older Adults ◽

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Cardiovascular Risk Factors ◽

Very Old ◽

Nsaid Prescription ◽

Young Old

Abstract Background and Aims Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with cardiovascular and kidney adverse effects, especially in older adults. However, NSAIDs are still frequently prescribed to some at-risk groups. We aimed to evaluate the burden of traditional cardiovascular risk factors and pattern of NSAID prescription in the very-old and young-old. Method Cross-sectional study of older adults who received prescriptions over 3 years from a large healthcare cluster in Singapore. Individuals aged 65-79 years were the “young-old” and those ≥80 years were the “very-old”. Prescriptions and traditional cardiovascular risk factors were retrieved from electronic records. Results Among 197,932 older adults (including 41,079 very-old), 49.9% received at least 1 NSAID prescription. Topical NSAIDs were more frequently prescribed among the 19,979 very-old with NSAID prescriptions (91.5% versus 82.9% of the young-old), while oral non-selective (22.1% versus 38.5%) and selective NSAID (15.1% versus 24.9%) were less frequently prescribed compared to the young-old (all p<0.001). The very-old with NSAID prescriptions were more likely to have diabetes (38.2% vs. 32.8%), hypertension (19.3% vs. 14.0%), chronic kidney disease (51.4% vs. 23.6%) and cardiovascular disease (7.0% vs. 3.8%) than the young-old with NSAID prescriptions (all p<0.001). Table 1 shows that among the very-old, the odds of receiving oral non-selective NSAIDs was significantly lower in those with cardiovascular disease, while the odds of receiving oral COX II inhibitors was significantly higher in female and hypertension. Among the young-old, the odds of receiving oral non-selective NSAID was lower in those with cardiovascular disease, diabetes and chronic kidney disease, while the odds of receiving oral COX II inhibitors was higher in female, hypertension, cardiovascular disease and lower in diabetes and chronic kidney disease. Conclusion This study highlights that NSAIDs were frequently prescribed among older adults with comorbidities that may predispose to NSAID-associated adverse events. Physician education and policies are required to avoid potentially inappropriate prescriptions.

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Association of Nutrition Education and Its Interaction with Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors among Chronic Kidney Disease Patients in Taiwan

Nutrients ◽

10.3390/nu13020298 ◽

2021 ◽

Vol 13 (2) ◽

pp. 298

Author(s):

Adi-Lukas Kurniawan ◽

Ya-Lan Yang ◽

Mei-Yun Chin ◽

Chien-Yeh Hsu ◽

Rathi Paramastri ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Cardiovascular Risk Factors ◽

Nutrition Education ◽

Kidney Function ◽

Lifestyle Factors ◽

Interactive Effects

We evaluated the interactive effects of nutrition education (NE) and lifestyle factors on kidney function parameters and cardiovascular risk factors among chronic kidney disease (CKD) patients. This cross-sectional cohort study recruited 2176 CKD stages 3–5 patients aged > 20 years from Integrated Chronic Kidney Disease Care Network, Shuang Ho Hospital, Taiwan between December 2008 and April 2019. The multivariable regression analysis was performed to investigate the interactive effects of NE with lifestyle factors on kidney function parameters and cardiovascular risk factors. Relative excess risk due to interaction (RERI) and attributable proportion (AP) were applied to assess additive interaction. Patients who were smoking or physically inactive but received NE had better estimated glomerular filtration rate (eGFR) (β: 3.83, 95% CI: 1.17–6.49 or β: 3.67, 95% CI: 2.04–5.29) compared to those without NE. Patients with smoking and NE significantly reduced risks for having high glycated hemoglobin A1c (HbA1c) by 47%, high low-density lipoprotein cholesterol (LDL-C) by 38%, and high corrected calcium (C-Ca) by 50% compared to those without NE. Moreover, NE and smoking or inactive physical activity exhibited an excess risk of high C-Ca (RERI: 0.47, 95% CI: 0.09–0.85 for smoking or RERI: 0.46, 95% CI: 0.01–0.90 and AP: 0.51, 95% CI: 0.03–0.99 for physical activity). Our study suggests that CKD patients who were enrolled in the NE program had better kidney function. Thus, NE could be associated with slowing kidney function decline and improving cardiovascular risk factors.

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