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 < 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.

The impact of comorbid chronic kidney disease and diabetes on health-related quality-of-life: a 12-year community cohort study

2020 ◽  
Author(s):  
Melanie L R Wyld ◽  
Rachael L Morton ◽  
Leyla Aouad ◽  
Dianna Magliano ◽  
Kevan R Polkinghorne ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Short Form ◽  
Mixed Effect ◽  
Linear Mixed Effect ◽  
Prospective Longitudinal ◽  
The Impact

Abstract Background Quality-of-life is an essential outcome for clinical care. Both chronic kidney disease (CKD) and diabetes have been associated with poorer quality-of-life. The combined impact of having both diseases is less well understood. As diabetes is the most common cause of CKD, it is imperative that we deepen our understanding of their joint impact. Methods This was a prospective, longitudinal cohort study of community-based Australians aged ≥25 years who participated in the Australian Diabetes, Obesity and Lifestyle study. Quality-of-life was measured by physical component summary (PCS) and mental component summary sub-scores of the Short Form (36) Health Survey. Univariate and multivariate linear mixed effect regressions were performed. Results Of the 11 081 participants with quality-of-life measurements at baseline, 1112 had CKD, 1001 had diabetes and of these 271 had both. Of the 1112 with CKD 421 had Stage 1, 314 had Stage 2, 346 had Stage 3 and 31 had Stages 4/5. Adjusted linear mixed effect models showed baseline PCS was lower for those with both CKD and diabetes compared with either disease alone (P < 0.001). Longitudinal analysis demonstrated a more rapid decline in PCS in those with both diseases. Conclusions The combination of CKD and diabetes has a powerful adverse impact on quality-of-life, and participants with both diseases had significantly poorer quality-of-life than those with one condition.

scholarly journals Association of Albuminuria and Estimated Glomerular Filtration Rate with Functional Performance Measures in Older Adults with Chronic Kidney Disease

2017 ◽  
Vol 45 (2) ◽  
pp. 172-179 ◽  
Author(s):  
Dawn F. Wolfgram ◽  
Katelyn Garcia ◽  
Greg Evans ◽  
Sara Zamanian ◽  
Rocky Tang ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Functional Status ◽  
Glomerular Filtration ◽  
Functional Impairment ◽  
Gait Speed ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate

Background: Chronic kidney disease (CKD) is increasingly common and disproportionately affects older adults. The contribution of kidney disease to the functional impairment noted in the elderly CKD population is unclear. Methods: This is a cross-sectional analysis of a hypertensive cohort of people aged ≥75 years from the Systolic Blood Pressure Intervention Trial. We evaluated estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) as predictors of 3 measures of functional status: EuroQol-5 Dimensional (EQ-5D) score, Falls Efficacy Scale (FES) score, and gait speed. Linear regression models were used to evaluate the associations between our independent variables and outcome measures. Results: Our analysis included 2,620 participants, mean age of 79.9 (4.0) years. Unadjusted models showed that lower eGFR level and higher UACR level were associated with lower EQ-5D (p < 0.001 for both) and slower gait speed (p < 0.001 for both) and worse scores on FES (p = 0.032 and p = 0.039). In the fully adjusted models, higher levels of UACR remained significantly associated with lower EQ-5D scores and slower gait speed (p = 0.011 and p = 0.002, respectively). In contrast, level of eGFR was not associated with any functional outcome measures when accounting for covariates. Conclusions: In individuals aged ≥75 years, albuminuria and eGFR were associated with impairments in physical performance and self-reported functional status; however, only the association with albuminuria remained after adjusting for relevant demographics and comorbidities. Evaluation of albuminuria may provide an additional tool for identifying older individuals at risk for functional impairment.

scholarly journals Accounting for the Competing Risk of Death to Predict Kidney Failure in Adults With Stage 4 Chronic Kidney Disease

2021 ◽  
Vol 4 (5) ◽  
pp. e219225
Author(s):  
Huda Al-Wahsh ◽  
Navdeep Tangri ◽  
Rob Quinn ◽  
Ping Liu ◽  
Thomas Ferguson, MS ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Competing Risk ◽  
Risk Of Death ◽  
Stage 4

scholarly journals Anthropometric measurements and markers of renal function in adults and older adults

2016 ◽  
Vol 29 (2) ◽  
pp. 199-209
Author(s):  
Victoria Araujo Ganzaroli AMADOR ◽  
Ana Tereza Vaz de Sousa FREITAS ◽  
Alessandra Vitorino NAGHETTINI ◽  
Edna Regina Silva PEREIRA ◽  
Maria do Rosário Gondim PEIXOTO
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Waist Circumference ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Body Mass ◽  
Filtration Rate

Objective: To determine whether anthropometric indicators are associated with markers of renal function in adults and older adults. Methods: This cross-sectional study included 279 adults and older adults attending eight primary healthcare units in eastern Goiânia, Góias. Sociodemographic, lifestyle, and clinical data were collected using a standard questionnaire. Body mass index was categorized as overweight (≥25 kg/m²) or non-overweight. Waist circumference was classified as normal or high; chronic kidney disease was defined as a glomerular filtration rate below 60 mL/minutes/1.73 m²; micro/macroalbuminuria was defined as an albumin/creatinine ratio above 30 mg/g. The association between anthropometric indicators and renal function markers was assessed by multiple linear regression analysis. Results: Chronic kidney disease was present in 8.9% and micro/macroalbuminuria in 34.8% of the sample. The prevalence of overweight was 57.0%. Waist circumference and body mass index were positively associated with glomerular filtration rate, characterized as glomerular hyperfiltration. Microalbuminuria was positively associated with body mass index in women. Conclusion: The prevalences of chronic kidney disease and overweight were high in the study population. Overweight was positively associated with glomerular filtration rate.

scholarly journals Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (1) ◽  
pp. 326
Author(s):  
Chih-Chien Chiu ◽  
Ya-Chieh Chang ◽  
Ren-Yeong Huang ◽  
Jenq-Shyong Chan ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Root Canal ◽  
Dialysis Patients ◽  
Root Canal Therapy ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

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