Abstract
Background
The incidence of end-stage renal disease (ESRD) is increasing in elderly patients with chronic kidney disease (CKD). This contradicts the general notion that elderly people are more likely to die than to ever reach ESRD. And racial disparity in relation to age on kidney disease outcomes has always been a subject of research interest.
Aims
We investigated the effect of age on outcome in a cohort with stages 3–5 CKD patients by age category.
Methods
A total of 430 patients with a mean age of 65.6 years were enrolled and followed till death, ESRD, or end of 2015. Multivariable Cox regression was used to identify predictors of all-cause mortality. Competing risk-adjusted Cox regression was used to identify determinants of ESRD. The median follow-up was 7.3 (interquartile range 8.8) years.
Results
Cox regression showed old age and low mean arterial pressure were predictors of mortality before and after onset of ESRD. Competing risk analysis revealed patients aged 20–39 years and 40–64 years exhibited greater risks of ESRD, compared to those aged over 75 years. These effects of age on outcomes occurred independently of traditional risk factors such as low estimated glomerular filtration rate and high proteinuria.
Conclusions
Age over 75 years is associated with decreased risk for ESRD even after adjustment for competing mortality. Given the global trends in population aging, there is a need to develop age-specific strategies, on top of the existing stage-based measures, to optimize the management of CKD in the elderly.
Similar content being viewed by others
References
US Renal Data System (USRDS). USRDS 2017 annual data report: Atlas of chronic kidney disease and end-stage renal disease in the United States. https://www.usrds.org/2017/view/v2_11.aspx. Accessed 6 Jan 2018
Taiwan Bureau of National Health Insurance. Taiwan the national health insurance statistics 2016. Table 79 outpatient medical benefit claims of dialysis by age, gender, NHI Regional Division and Locale. https://www.nhi.gov.tw/english/Content_List.aspx?n=053561BC02D74A95&topn=616B97F8DF2C3614. Accessed 6 Jan 2018
Chen YR, Yang Y, Wang SC et al (2013) Effectiveness of multidisciplinary care for chronic kidney disease in Taiwan: a 3-year prospective cohort study. Nephrol Dial Transplant 28:671–682. https://doi.org/10.1093/ndt/gfs469
Chen PM, Lai TS, Chen PY et al (2015) Multidisciplinary care program for advanced chronic kidney disease: reduces renal replacement and medical costs. Am J Med 128:68–76. https://doi.org/10.1016/j.amjmed.2014.07.042
O’Hare AM, Choi AI, Bertenthal D et al (2007) Age affects outcomes in chronic kidney disease. J Am Soc Nephrol 18:2758–2765. https://doi.org/10.1681/asn.2007040422
Keith DS, Nichols GA, Gullion CM et al (2004) Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 164:659–663. https://doi.org/10.1001/archinte.164.6.659
Chiu YL, Chien KL, Lin SL et al (2008) Outcomes of stage 3–5 chronic kidney disease before end-stage renal disease at a single center in Taiwan. Nephron Clin Pract 109:c109–118. https://doi.org/10.1159/000145453
Lin CM, Yang MC, Hwang SJ et al (2013) Progression of stages 3b-5 chronic kidney disease—preliminary results of Taiwan national pre-ESRD disease management program in Southern Taiwan. J Formos Med Assoc 112:773–782. https://doi.org/10.1016/j.jfma.2013.10.021
Kuo W-H, Ng H-Y, Chien Y-S et al (2012) Renal outcome of patients with chronic kidney disease stage 3–5 under a multidisciplinary care program. Acta Nephrol 26:206–212
Hall YN, Sugihara JG, Go AS et al (2005) Differential mortality and transplantation rates among Asians and Pacific Islanders with ESRD. J Am Soc Nephrol 16:3711–3720. https://doi.org/10.1681/asn.2005060580
Derose SF, Rutkowski MP, Crooks PW et al (2013) Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system. Am J Kidney Dis 62:236–244. https://doi.org/10.1053/j.ajkd.2013.01.019
Tsai CW, Ting IW, Yeh HC et al (2017) Longitudinal change in estimated GFR among CKD patients: a 10-year follow-up study of an integrated kidney disease care program in Taiwan. PLoS One 12:e0173843. https://doi.org/10.1371/journal.pone.0173843
Levey AS, Greene T, Kusek JW et al (2000) A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol 11:155A
Grams ME, Coresh J, Segev DL et al (2012) Vascular disease, ESRD, and death: interpreting competing risk analyses. Clin J Am Soc Nephrol 7:1606–1614. https://doi.org/10.2215/cjn.03460412
Wong JS, Port FK, Hulbert-Shearon TE et al (1999) Survival advantage in Asian American end-stage renal disease patients. Kidney Int 55:2515–2523. https://doi.org/10.1046/j.1523-1755.1999.00464.x
De Nicola L, Minutolo R, Chiodini P et al (2012) The effect of increasing age on the prognosis of non-dialysis patients with chronic kidney disease receiving stable nephrology care. Kidney Int 82:482–488. https://doi.org/10.1038/ki.2012.174
O’Hare AM, Bertenthal D, Covinsky KE et al (2006) Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol 17:846–853. https://doi.org/10.1681/asn.2005090986
Hallan SI, Matsushita K, Sang Y et al (2012) Age and association of kidney measures with mortality and end-stage renal disease. JAMA 308:2349–2360. https://doi.org/10.1001/jama.2012.16817
Wan EYF, Fong DYT, Fung CSC et al (2017) Prediction of new onset of end stage renal disease in Chinese patients with type 2 diabetes mellitus—a population-based retrospective cohort study. BMC Nephrol 18:257. https://doi.org/10.1186/s12882-017-0671-x
Tangri N, Stevens LA, Griffith J et al (2011) A predictive model for progression of chronic kidney disease to kidney failure. JAMA 305:1553–1559 https://doi.org/10.1001/jama.2011.451
Lin CC, Li CI, Liu CS et al (2017) Development and validation of a risk prediction model for end-stage renal disease in patients with type 2 diabetes. Sci Rep 7:10177. https://doi.org/10.1038/s41598-017-09243-9
Ishani A, Xue JL, Himmelfarb J et al (2009) Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol 20:223–228. https://doi.org/10.1681/asn.2007080837
Ferenbach DA, Bonventre JV (2015) Mechanisms of maladaptive repair after AKI leading to accelerated kidney ageing and CKD. Nat Rev Nephrol 11:264–276. https://doi.org/10.1038/nrneph.2015.3
Chou YH, Huang TM, Pan SY et al (2017) Renin–angiotensin system inhibitor is associated with lower risk of ensuing chronic kidney disease after functional recovery from acute kidney injury. Sci Rep 7:46518. https://doi.org/10.1038/srep46518
Landray MJ, Emberson JR, Blackwell L et al (2010) Prediction of ESRD and death among people with CKD: the Chronic Renal Impairment in Birmingham (CRIB) prospective cohort study. Am J Kidney Dis 56:1082–1094. https://doi.org/10.1053/j.ajkd.2010.07.016
Remuzzi G, Chiurchiu C, Ruggenenti P (2004) Proteinuria predicting outcome in renal disease: nondiabetic nephropathies (REIN). Kidney Int Suppl. https://doi.org/10.1111/j.1523-1755.2004.09221.x
de Zeeuw D, Remuzzi G, Parving HH et al (2004) Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney Int 65:2309–2320. https://doi.org/10.1111/j.1523-1755.2004.00653.x
Morgan CL, Currie CJ, Peters JR (2000) Relationship between diabetes and mortality: a population study using record linkage. Diabetes Care 23:1103–1107
Tong J, Liu M, Li H et al (2016) Mortality and associated risk factors in dialysis patients with cardiovascular disease. Kidney Blood Press Res 41:479–487. https://doi.org/10.1159/000443449
Lu JL, Kalantar-Zadeh K, Ma JZ et al (2014) Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol 25:2088–2096 https://doi.org/10.1681/asn.2013070754
Navaneethan SD, Schold JD, Jolly SE et al (2017) Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease. Kidney Int 92:1272–1281. https://doi.org/10.1016/j.kint.2017.04.030
Chen LI, Guh JY, Wu KD et al (2014) Modification of diet in renal disease (MDRD) study and CKD epidemiology collaboration (CKD-EPI) equations for Taiwanese adults. PLoS One 9:e99645 https://doi.org/10.1371/journal.pone.0099645
Gerstein HC, Mann JF, Yi Q et al (2001) Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 286:421–426
Brenner BM, Cooper ME, de Zeeuw D et al (2001) Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 345:861–869. https://doi.org/10.1056/NEJMoa011161
Lai TS, Chiang WC, Chen YM (2016) Pentoxifylline: evidence strong enough for renoprotection? J Formos Med Assoc 115:591–592. https://doi.org/10.1016/j.jfma.2015.12.010
Sharp Collaborative G (2010) Study of Heart and Renal Protection (SHARP): randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease. Am Heart J 160:785 e710–794 e710 https://doi.org/10.1016/j.ahj.2010.08.012
Acknowledgements
The authors acknowledge statistical assistance provided by the Center of Statistical Consultation and Research in the Department of Medical Research, National Taiwan University Hospital. This study was supported in part by grants from the National Taiwan University Hospital (105-003126), the Ta-Tung Kidney Foundation, and the Mrs Hsiu-Chin Lee Kidney Research Fund, Taipei, Taiwan.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflict of interest to declare.
Ethical standards
This study was approved by the Research and Ethics Committee of the National Taiwan University Hospital.
Statement of human and animal rights
The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.
Informed consent
No informed consent requirement was required by the Research and Ethics Committee of the National Taiwan University Hospital.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Chou, YH., Yen, CJ., Lai, TS. et al. Old age is a positive modifier of renal outcome in Taiwanese patients with stages 3–5 chronic kidney disease. Aging Clin Exp Res 31, 1651–1659 (2019). https://doi.org/10.1007/s40520-018-01117-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-018-01117-y