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Age and Association of Kidney Measures With Mortality and End-Stage Renal Disease
Study Questions:
What is the effect modification (interaction) by age of the association of biochemical measures of chronic kidney disease—estimated glomerular filtration rate (eGFR) and albuminuria—on risk for mortality and end-stage renal disease (ESRD)?
Methods:
This was a meta-analysis of more than 2 million participants from 46 different cohorts contained within the Chronic Kidney Disease Prognosis Consortium (CKD-PC). The primary endpoints were all-cause mortality and ESRD.
Results:
Absolute mortality risk differences for reduced eGFR increased with increasing age. Adjusted absolute risk differences for an eGFR of 45 ml/min/1.73 m2 versus 80 ml/min/1.73 m2 were 9.0 (95% confidence interval [CI], 6.0-12.8), 12.2 (95% CI, 10.3-14.3), 13.3 (95% CI, 9.0-18.6), and 27.2 (95% CI, 13.5-45.5) excess deaths per 1,000 person-years in age categories 18-54, 55-64, 65-74, and ≥75 years, respectively.
Conclusions:
Compared to middle-aged counterparts, the absolute risk for excess mortality associated with chronic kidney disease (as assessed by both low eGFR and high albuminuria) is as high or even higher among older adults.
Perspective:
The present study drawn from a large number of participants should settle concerns that low eGFR reflects only natural aging. The data would convincingly suggest that older adults with CKD are a population at high risk for adverse outcomes and should not be overlooked. It would be useful to further establish that interventions to prevent CKD progression or CKD-related outcomes are similarly effective, safe, and tolerable across categories of age. In the meanwhile, it is clear that CKD is a ‘challenge for all ages.’ (de Boer IH. Chronic Kidney Disease—A Challenge for All Ages. JAMA 2012).
Keywords: Prognosis, Renal Insufficiency, Cardiology, Middle Aged, Cardiovascular Diseases, Glomerular Filtration Rate, Confidence Intervals, Diabetic Nephropathies, Disease Progression
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