The Continued Quest for Optimal BP Targets in Older Adults with Kidney Disease

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.

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Prioritizing the quality of life of older adults with kidney disease

Nature Reviews Nephrology ◽

10.1038/s41581-021-00397-4 ◽

2021 ◽

Vol 17 (3) ◽

pp. 149-150

Author(s):

Rasheeda K. Hall

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Kidney Disease

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

The Journals of Gerontology Series A ◽

10.1093/gerona/glz294 ◽

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 < .05), and while attenuated, remained significant (B = −0.79, p < .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.

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

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2009.02561.x ◽

2009 ◽

Vol 57 (12) ◽

pp. 2217-2223 ◽

Cited By ~ 23

Author(s):

Balsam El-Ghoul ◽

Caroline Elie ◽

Tarek Sqalli ◽

Paul Jungers ◽

Michel Daudon ◽

...

Keyword(s):

Older Adults ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Dysfunction

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Impact of Self-Report and eGFR-Based Chronic Kidney Disease on the Risk of Chronic Kidney Disease-Related Complications and Geriatric Syndromes in Community-Dwelling Older Adults

Kidney & Blood Pressure Research ◽

10.1159/000496002 ◽

2018 ◽

Vol 43 (6) ◽

pp. 1908-1918 ◽

Cited By ~ 2

Author(s):

Chia-Ter Chao ◽

Yi-Hsuan Lee ◽

Kuen-Cheh Yang ◽

Jen-Kuei Peng ◽

Chia-Ming Li ◽

...

Keyword(s):

Older Adults ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Community Dwelling ◽

Self Report ◽

Geriatric Syndromes ◽

Community Dwelling Older Adults

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

Frontiers in Medicine ◽

10.3389/fmed.2021.760391 ◽

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 < 22 kg/m2, serum albumin < 3.0 mg/dL, or Geriatric Nutritional Risk Index (GNRI) < 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.

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Abstract 18787: Hypertension Treatment and Control Rates in United States Adults by Risk Group

Circulation ◽

10.1161/circ.130.suppl_2.18787 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Kunal N Karmali ◽

Hongyan Ning ◽

Donald M Lloyd-Jones

Keyword(s):

Older Adults ◽

High Risk ◽

Kidney Disease ◽

Risk Group ◽

Intensive Therapy ◽

Risk Groups ◽

Middle Aged ◽

Ascvd Risk ◽

Middle Aged Adults ◽

And Control

Introduction: Ten-year cardiovascular disease (CVD) risk and absolute benefit from antihypertensive therapy vary at any given BP based on associated risk factor levels. Thus, implications of treatment and control rates at a particular BP vary substantially in different risk groups. Objectives: We examined the prevalence, treatment, and control of hypertension (HTN) by risk group in US adults without prevalent CVD. Methods: We used data from the National Health and Nutrition Examination Survey 2005 to 2010 for adults age 40-79 years without prevalent CVD (n=4,066). We estimated 10-year risk for an atherosclerotic CVD (ASCVD) event using the ACC/AHA 2013 Pooled Cohort risk equations. We examined HTN treatment and control rates according to current guidelines in middle-aged (40-59 years) and older (60-79 years) adults with: 10-year ASCVD risk <7.5% (no diabetes/kidney disease); 10-year ASCVD risk ≥7.5% (no diabetes/kidney disease); and either diabetes or kidney disease. Results: The proportion of adults with treatment-eligible HTN was 39.3% for those with 10-year ASCVD risk <7.5%, 32.2% for those with 10-year ASCVD risk ≥7.5%, and 28.4% for those with either diabetes or kidney disease (see Table 1). Treatment rates across the risk groups varied from 51.5% to 79.0% for middle-aged adults and 81.8% to 90.2% for older adults. HTN control rates were highest (87.7%) in older adults with 10-year ASCVD risk <7.5% but were lowest (29.3%) in middle-aged individuals with 10-year ASCVD risk ≥7.5%. Conclusions: US HTN guidelines, based solely on BP thresholds, identify a higher proportion of low-risk adults and a lower proportion of high-risk adults as being eligible for treatment. Control rates remain suboptimal in high-risk individuals, particularly middle-aged adults. Future guidelines should consider pre-treatment risk stratification to identify those at increased pretreatment ASCVD risk who would benefit most from more intensive therapy.

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Management of acute kidney injury and chronic kidney disease

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0141 ◽

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.

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