Chronic kidney disease in older patients: the contribution of kidney pathology to the estimated glomerular filtration

 

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https://storage.unitedwebnetwork.com/files/1099/207eac7149f833cd670c47f5e69c32a2.pdf
Chronic kidney disease in older patients: the contribution of kidney pathology to the estimated glomerular filtration

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Elena
Efremova
Elena Efremova lena_1953@mail.ru Ulyanovsk State University Department of Therapy and Occupational Diseases Ulyanovsk Russia *
Alexander Shutov amshu@msil.ru Ulyanovsk State University Department of Therapy and Occupational Diseases Ulyanovsk Russia -
Tatyana Kuznecova kuznecovatatjana@yandex.ru Ulyanovsk Regional Clinical Hospital nephrology department Ulyanovsk Russia -
Timur Bakher Tay.baher@hotmail.com First Pavlov State Medical University of St. Petersburg Faculty of internal medicine St. Petersburg Russia -
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In elderly and senile patients, chronic kidney disease (CKD) is not always diagnosed promptly and is often attributed to age-related changes in kidney function. Estimated glomerular filtration rate (eGFR) does not allow one to determine the contribution of pathology to eGFR, as this indicator also includes age-related decline in kidney function. The aim of the study was to assess the contribution of kidney pathology to the estimated glomerular filtration rate and its prognostic value in elderly and senile patients.

472 elderly and senile age patients (241 women and 231 men, mean age 69.6±7.3 years) with stable cardiovascular diseases were examined. CKD was observed in 302 (63.9 %) elderly and senile patients. Estimated glomerular filtration rate (eGFR) was determined using the CKD-EPI equation (modified 2011). The contribution of kidney pathology (CKP) to eGFR was calculated by the difference between the “real” eGFR (calculated using the CKD-EPI, 2011 formula based on the “real” serum creatinine) and the predicted eGFR for a given age and sex (patent No. RU 2723748 C1). The follow-up period was 12 months. The primary endpoint was overall mortality.

The CKP in eGFR in elderly and senile patients was 26.3 (14.9;35.7) %, increasing with the severity of CKD. The CKP in eGFR in elderly and senile patients with CKD did not differ depending on gender and age (p>0.05). The modified Charlson comorbidity index was higher in patients with CKD with CKP in eGFR more than 43.3 % compared to patients with The CKP in eGFR less than 43.3 (p = 0.004). The CKP in eGFR more than 43.3 % was associated with a 1-year risk of death in patients with CKD (OR 4.7; 95 % CI 1.99–10.9; p<0.0001). When assessing the prognostic value of CKP in eGFR, regardless of the CKD it was found that an increase CKP in eGFR more than 17.9 % was associated with a 1-year risk of death in elderly and senile patients with stable cardiovascular diseases (OR 2.47; 95 % CI 1.31–4.67; p=0.004).

The contribution of kidney pathology in eGFR in elderly and senile patients with CKD and stable cardiovascular comorbidity increases with the severity of CKD and does not depend on gender and age. In elderly and senile patients with stable cardiovascular diseases, the CKP in eGFR has prognostic advantages when assessing annual mortality compared to eGFR assessment using the CKD EPI formula (2011).

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