Risk Factors of CKD Progression in Elderly Patients by Stratified Analysis from 60s to 80s

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Background: The recent high care and the managements for elderly patients have been improving their problems about the lower quality of life with malnutrition, frail, cognitive dysfunction, and others. Those approaches might also change the CKD progression and risk factors. This study analyzed 7 years renal prognosis and the risk factors for progression by the stratified analysis from 60s to 80s of CKD patients. Methods: The 328 elderly CKD out-patients who were visited our institution in January 2017 were divided into three groups according to the age of 60s, 70s, and 80s. The clinical and laboratory findings, and medication [renin angiotensin systems (RAS) inhibitors, statins, and any diuretics] were compared among these three groups, and the renal survival until end stage kidney disease (ESKD) and/or 50 % decrease of eGFR was analyzed by the Kaplan-Meier method and log-rank test. The risk factors for CKD progressions were analyzed by the univariate and multivariate Cox regression analysis in each 60s, 70s, and 80s. Results: The sex distributions, mean arterial pressure (MAP), and body mass index (BMI) were similar among three groups (60s/70s/80s; MAP: 94.8/92.7/93.2 mmHg, p=0.196, BMI: 24.8/23.8/23.8 kg/m2, p=0.054). Hemoglobin (Hb) and serum albumin were significant lower according to the ages (Hb: 12.6/12.0/11.7 g/dL, p<0.001, albumin: 3.9/3.8/3.7 mf/dL, p=0.005), but the eGFR (31.3/31.1/31.8 mL/min/1.73m2, p=0.106) and other laboratory factors were similar among three groups. The administrations of RAS inhibitors and statins were similar, but any diuretics were significantly higher according to the age (28.0/31.6/47.7 %, p=0.01). The renal survival rates were similar among three groups (68.0/58.6/59.1%, p=0.149). The univariate and multivariate analysis indicated that CKD stage and the amount of proteinuria was the significant risk factors in any ages, and the other risk factors were higher BMI in 60s [hazard ratio (HR): 1.47, 95% confidence interval (CI): 1.07-2.02, p=0.017], and lower Hb in 70’s (HR: 1.68, 95% CI: 1.28-2.21, p<0.001), but any medications were not related. Conclusion: These results indicated that we should pay attention to CKD stage and the amount of proteinuria in any elderly CKD patients. Moreover, we should also pay attention to obesity in 60s and anemia in 70s to prevent form progression of CKD.

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