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Chronic Kidney Disease (CKD) in the elderly population is more common than in other age groups, however, we must differentiate CKD from the process of nephrosenescence (NS), the HUGE formula (Hematocrit, Urea, Gender) helps us in the assessment of the elderly population with Glomerular filtration rate (GFR) < 60ml/min/1.73m2, avoiding the isolated use of serum creatinine and the GFR calculation based on it.
Adults 65-year-old and older baseline data and follow-up of at minimum 6 months information were included. The charting tabulation and analysis of the data was carried out using the SPSSv.26 program and Excel 2019
181 records were included, 70 (39%) patients had HUGE ≥ 0 (CKD); while 111 (61%) when applying HUGE they were considered NS.
In the NS group, 68% were female, while in the CKD group, only 32%. In both groups, 49% had Diabetes Mellitus (DM2). The 77% in the NS group had high blood pressure versus 84% in the CKD group.
The decrease in eGFR was greater in the NS group, with a reduction of 32.7 ml/min, versus 22.46 ml/mi in CKD group. Despite these results, the eGFR at the end of follow-up was higher in the NS group (43.5 ml /min vs 28 ml/min).
In this study we consider an accelerated deterioration a decrease of 10 ml/min/year, the NS group had a highest prevalence of it, without reaching statistical significance.
Based on the HUGE formula, 74% of the NS patients at the end of the follow up remained in the same group, while 26% changed to CKD group.
A subanalysis was performed, with using eGFR < 45 ml/min to diagnose CKD instead of < 60 ml/min, finding that 81% of patients by eGFR did not meet the CKD criteria, from them at the follow-up 55%, had decrease of eGFR < 45 ml/min. We found a 23% of the CKD patients met NS criteria at follow-up, showing a type of improvement of the disease.
The multivariate analysis showed that: the older age with OR=1.09 95%CI: 1.02-1.16 p:0.01 and the presence of proteinuria with OR=3.07, 95%CI: 1.17-8.06, p: 0.02, increased the decline risk in eGFR.
This study have sensitivity of 84%, specificity of 65%, with a likelihood ratio (+) of 2.4 and (-) of 0.25 when applying HUGE <0 and remaining the same at 34 months of follow-up
The HUGE formula in the Alvarez-Gregori study had a sensitivity of 92%, however it uses a subjective criteria, clinical opinion of two nephrologists, in this study we compared the considered the changes of eGFR between the groups of NS and CKD.
In our study the HUGE formula achieves well results, finding that those patients with NS have a lower probability of progression to CKD, however, one factor which does not match with previous studies, is the faster speed of progression in this group, once deterioration begins.
The main risk factor, which independently affects deterioration in our study, was the presence of proteinuria, which suggests that although an older adult patient with proteinuria is classified as having nephrosenescence, their follow-up should be closer than that patient of similar age, who does not present proteinuria.