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Mean (SD) estimated glomerular filtration rate (eGFR) of oldest old with and without vascular diseases/risk factors 1 .
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BACKGROUND:Kidney function declines considerably with age, but little is known about its clinical significance in the oldest-old. OBJECTIVES:To study the association between reduced glomerular filtration rate (GFR) estimated according to five equations with mortality in the oldest-old. DESIGN:Prospective population-based study. SETTING:Municipality...
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... the equation used, the 526 subjects with a history of hypertension, myocardial infarction, diabetes, heart failure, or stroke showed a mean eGFR lower than that of the 151 subjects without, with an average difference between groups of 5.8 mL/min/1.73m 2 (p = 0.003 using C-G and p <0.0001 using all the other equations) (see Table 3). ...
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... Third, the retrospective design of this study limited our ability to make causal associations. Nevertheless, the prognosis factors in our study are rational since previous studies have identified them as significant risk predictors for mortality in certain populations [16][17][18][19][20][21][22][23]. Last, we excluded patients who received leadless pacemaker implantation. ...
Background and Objectives: The demand for permanent pacemaker (PPM) implantation for extremely old patients is increasing. Prior to implanting PPMs, life expectancy evaluation is essential but difficult. We aimed to develop and validate a scoring system for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80. Materials and Methods: A total of 210 patients aged ≥80 who received PPM implantation were included. Multivariable analysis was performed to assess the effects of different variables on all-cause mortality in a derivation cohort (n = 100). We developed the MELODY score for stratifying all-cause mortality prior to PPM implantation and tested the scoring system in a validation cohort (n = 102). Results: After 4.0 ± 2.7 years of follow-up, 54 patients (54%) had died. The 0.5-, 1- and 2-year all-cause mortality rates were 7%, 10% and 24%, respectively. The MELODY score based on body mass index <21 kg/m2 (HR: 2.21, 95% CI: 1.06–4.61), estimated glomerular filtration rate <30 mL/min/1.73 m2 (3.35, 1.77–6.35), length of hospitalization before PPM implantation >7 days (1.87, 1.02–3.43) and dyspnea as the major presenting symptom (1.90, 1.03–3.50) successfully distinguished patients at high risk of mortality. Patients with MELODY scores ≥3 had a higher risk of mortality compared to those with MELODY scores <3 (8.49, 4.24–17.00). The areas under the receiver operating characteristic curves in predicting 0.5, 1 and 2 years mortality rates were 0.86, 0.81 and 0.74, respectively. The predictive value of the model was confirmed in a validation cohort. Conclusions: The novel scoring system is a simple and effective tool for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80.
... The Cockcroft-Gault modification of diet in renal disease (MDRD) equation was used to calculate eGFR, eGFR = 175 × (Scr) −1.154 × (Age) −0.203 × (0.742 if female) × (1.212 if Black). This equation was chosen because it was found that MDRD was more consistent over a 5-year period [10] with the smallest mean bias and highest accuracy in subjects with diabetes. From this, participants were stratified into two groups using eGFR cut off of 30 mL/min/1.73 2 (≤30 mL/min/1.73 2 and >30 mL/min/1.73 2 ). ...
Globally the population of older adults is the fastest growing age group. Estimated glomerular filtration rate (eGFR) is an estimation of true kidney function with lower eGFR associated with higher mortality. However, few studies explore eGFR’s prognostic value in the nonagenarian. We investigated the association between eGFR on admission and mortality among the nonagenarians hospitalised with acute illness. A retrospective analysis of a prospective cohort study included patients aged ≥ 90 admitted into three acute medical assessment units or acute geriatric wards in England and Scotland between November 2008 and January 2009. Association between eGFR and all-cause mortality was evaluated using the Cox proportional hazard models controlling for potential confounders including frailty. 392 patients with mean (SD) 93.0 ± 2.6 years (68.45% women) were included. The median (IQR) eGFR was 26.61 (18.41–40.41) mL/min/1.732. 63 died in in hospital. Low eGFR was not associated with mortality (Hazard ratio (HR) 1.00 (95% CI 0.98–1.02) overall or in sub–group analysis by frailty (HR 0.96 (0.92–1.01)) or by eGFR of ≤30 (HR 1.01 (0.95–1.06). We found no evidence of prognostic value of eGFR in predicting in–hospital mortality in the acutely unwell hospitalised nonagenarians.
... Remarkably, estimation of GFR in the elderly is still a matter of debate as all equations integrate age with different mathematical models. Many studies have shown that distinct GFR estimations give different results in very old patients, raising concerns about which equation should be most appropriately used in this population [38,[61][62][63]. ...
Background:
This paper aims to evaluate the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and alternative equations and to assess their predictive power for all-cause mortality in unselected patients discharged alive from a cardiology ward.
Methods:
We retrospectively included patients admitted to our Cardiology Division independently of their diagnosis. The total population was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) categories, as follows: G1 (estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m2); G2 (eGFR 89-60 mL/min/1.73 m2); G3a (eGFR 59-45 mL/min/1.73 m2); G3b (eGFR 44-30 mL/min/1.73 m2); G4 (eGFR 29-15 mL/min/1.73 m2); G5 (eGFR <15 mL/min/1.73 m2). Cockcroft-Gault (CG), CG adjusted for body surface area (CG-BSA), Modification of Diet in Renal Disease (MDRD), Berlin Initiative Study (BIS-1), and Full Age Spectrum (FAS) equations were also assessed.
Results:
A total of 806 patients were included. Good agreement was found between the CKD-EPI formula and CG-BSA, MDRD, BIS-1, and FAS equations. In subjects younger than 65 years or aged ≥85 years, CKD-EPI and MDRD showed the highest agreement (Cohen's kappa (K) 0.881 and 0.588, respectively) while CG showed the lowest. After a median follow-up of 407 days, overall mortality was 8.2%. The risk of death was higher in lower eGFR classes (G3b HR4.35; 95%CI 1.05-17.80; G4 HR7.13; 95%CI 1.63-31.23; G5 HR25.91; 95%CI 6.63-101.21). The discriminant capability of death prediction tested with ROC curves showed the best results for BIS-1 and FAS equations.
Conclusion:
In our cohort, the concordance between CKD-EPI and other equations decreased with age, with the MDRD formula showing the best agreement in both younger and older patients. Overall, mortality rates increased with the renal function decreasing. In patients aged ≥75 years, the best discriminant capability for death prediction was found for BIS-1 and FAS equations.
... While the Mayo formula was found to accurately predict mortality in our cohort, it is less widely used, has not been validated in diverse populations and is not currently recommended by any nephrology practice guidelines. Furthermore, previous reports have shown that the Mayo equation proved inaccurate in type-2 diabetic patients with hyperfiltration [23] or normal renal function [24] and in the very elderly [25,26]. ...
Background
Renal function plays a significant role in the prognosis and management of patients with multi-vessel coronary artery disease (CAD) referred for revascularization. Current data lack precise risk stratification using estimated glomerular filtration rate (eGFR) and creatinine clearance.
Methods
This prospective study includes a three-year follow-up of 1112 consecutive patients with multi-vessel CAD enrolled in the 22 hospitals in Israel that perform coronary angiography.
Results
The Mayo formula yielded the highest mean eGFR (90 ± 26 mL/min per 1.73m ² ) and chronic kidney disease-epidemiology collaboration (CKD-EPI) the lowest (76 ± 24 mL/min per 1.73m ² ). Consequently, the Mayo formula classified more patients (56%) as having normal renal function. There was a significant and strong correlation between the values obtained from all five formulas using Cockcroft-Gault as the reference formula: Mayo: r = 0.80, p < 0.001; CKD-EPI: r = 0.87, p < 0.001; modification of diet in renal disease (MDRD): r = 0.84, p < 0.001; inulin clearance-based: r = 0.99, p < 0.001). Multivariable analysis demonstrated that decreased renal function is an independent predictor of 3-year mortality in all five formulas, with risk increasing by 15–25% for each 10-unit decrease in eGFR. Despite the similarities between the formulas, the ability to predict mortality was highest in the Mayo formula and lowest in MDRD.
Conclusions
Our data suggest that while the Mayo formula is not currently recommended by any nephrology guidelines, it may be an alternative formula to predict mortality among patients with multivessel CAD, including to the widely used MDRD formula.
... The estimated Glomerular Filtration Rate (eGFR) was ascertained exactly using the formula of the Modification of Diet in Renal Disease (MDRD) equation for Taiwanese adults [18]. We chose the MDRD equation for the present study because a previous study of an oldest-old population found that this equation best-predicted mortality when eGFR was between 45 and 59 mL/min/ 1.73m 2 [19]. Although it remains controversial as to which eGFR threshold should be referred to determine CKD in geriatrics, CKD has frequently been specified as an eGFR< 60 ml/min/1.73m 2 for at least 3 months, in accordance with the Kidney Disease Improving Global Outcome (KDIGO) Clinical Practice Guideline, as selfreported by the patients or retrieved from electronic records. ...
Background: Chronic kidney disease (CKD), low serum albumin, and anemia are known risk factors for cognitive decline in older people. We investigated the association between kidney function and cognitive impairment severity in oldest-old people with a diagnosis of Alzheimer’s disease (AD).
Methods: A cross-sectional study of patients aged 80 years and older was conducted at a veterans’ home in Taiwan between 2012 and 2016. Their estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Diseases (MDRD) equation. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR).
Results: A total of 84 patients (age mean ± SD, 86.6 ± 3.9 years) had MMSE scores of 10.1 ± 6.7, and CDR scores of 2
1.6 ± 0.7. The average eGFR was 61.7 ± 21.5 mL/min/1.73m . The mean hemoglobin concentration was 12.7 ± 1.7 g/ dl, and the mean albumin concentration was 4.5 ± 4.8 g/dl. Multivariate regression analyses showed that scores of CDR were significantly correlated with eGFR after adjustment for potential confounders. The scores of MMSE were significantly correlated with serum albumin and hemoglobin after adjustment for potential confounders.
Conclusions: We found dementia severity was significantly associated with kidney function, serum albumin, and hemoglobin in the oldest-old with AD. We recommend that oldest-old people with a diagnosis of AD be evaluated to determine kidney function, as well as nutritional and hematological status. Further study is needed to establish whether prevention of CKD deterioration, and correction of malnutrition and anemia may help to slow cognitive decline in oldest-old people with dementia.
... The mean GFR of the current study population estimated by BIS, CKD-EPI or MDRD equations was 5 to 10 mL/min/1.73 m 2 higher than the averages reported in previous studies for older people, 6,16,[38][39][40][41][42][43] perhaps due to survival bias in our exceptional longevity setting. 29 People with severe disease are more likely to die earlier. ...
Purpose
Reduced kidney function has been associated with an increased risk for adverse outcomes. Accurate assessment of glomerular filtration rate (GFR) is key to diagnosis and management of kidney disfunction. Debate exists on the best GFR estimation equation for elderly people. This study aimed to compare the predictive validity and discriminative ability of four GFR equations in relation to 2-year and 6-year mortality in exceptional longevity (EL) (those over 95 years old with intact health) individuals and is an ideal model to address factors relating to life span and age-related diseases.
Patients and Methods
This study used 6 years’ data of 278 EL from the Rugao longevity cohort. Baseline GFR was estimated using four equations: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, Modification of Diet in Renal Disease Study (MDRD) equation, Berlin Initiative Study-1 (BIS) equation, and modified MDRD equation. Predictive validity was tested using Cox proportional hazards analysis. Overall improvement in reclassification based on estimated GFR (eGFR) was assessed applying net reclassification improvement (NRI).
Results
Mean age of participants was 97±2 years with median follow-up of 2.6 years. Median (IQR) eGFR by CKD-EPI, MDRD, BIS, and modified MDRD equations were 73.9 (62.2–77.6), 82.3 (67.4–98.6), 56.4 (47.9–63.9), and 101.5 (83.1–121.6) mL/min per 1.73 m², respectively. Higher eGFREPI was associated with lower mortality after multivariate adjustment (for continuous eGFREPI, HRtwo-year 1.018, 95% CI 1.002–1.033, P=0.023; HRsix-year 1.013, 95% CI 1.002–1.025, P=0.022), while eGFR from other equations did not show any associations with mortality. NRI for two-year mortality was 0.14 and approximately significant, which may favor the CKD-EPI when compared to BIS equation (P=0.052).
Conclusion
The CKD-EPI equation showed more accurate estimation of kidney function in the elderly with respect to GFR distribution and predictability of mortality risk.
... One reason for conflicting results can be attributed to the limitations of creatinine as a marker for eGFR. This is highlighted by findings from the older general population cohort "Health and Anemia", in which different eGFR equations yielded very different prevalences of CKD and demonstrated a varying capacity to predict mortality [20]. The inclusion of cystatin C in estimating equations has been shown to improve GFR estimation [21] in our population of older adults. ...
Background
The prevailing diagnostic criteria for CKD are age-independent, but have been challenged in light of the eGFR decline associated with normal aging. The stages of CKD communicate magnitude of risk of ESRD, cardiovascular morbidity, and mortality.
Aims
This study aims to provide more insight into the morbidity and mortality associated with eGFR levels corresponding to the current CKD stages in older adults.
Methods
The 2931 older adults in the Good Aging in Skåne study were randomized from the general population. The exposure variable used was eGFR level (CKD-EPI based on creatinine and cystatin C) with eGFR 60–89 mL/min/1.73 m² as a reference; the outcomes were mortality, acute cardiovascular disease, congestive heart failure, and rapid kidney function decline (RKFD; defined as a decline in eGFR by 3 mL/min/1.73 m² per year or more).
Results
The mean age at baseline was 73 (SD 11) and mean follow-up time 11 (SD 5) years. Mortality was higher at lower eGFR levels with adjusted HR (95% CI) being 1.58 (1.34–1.88), 1.22 (1.05–1.41), 1 (reference), and 0.90 (0.67–1.21) for eGFR < 45, 45–59, 60–89 and ≥ 90 mL/min/1.73 m², respectively. For acute CVD the adjusted HR (95% CI) were 1.23 (0.81–1.87), 1.21 (0.87–1.69), 1 (reference), and 0.53 (0.28–1.00) for the same eGFR levels.
Conclusions
This study confirms that mortality in older adults increases with decreasing eGFR at eGFR levels below today’s threshold for CKD. The correlation was less certain for lower eGFR and incident cardiovascular disease.
... However, these authors have not tested other equations, such as the old CG equation in comparison with the MDRD or CKD-EPI equations. When compared to these two equations, the CG equation has been shown to be better predictive of mortality in patients with STEMI or ischemic heart disease [10-12,20,21], but also in other cardiologic populations [48][49][50][51][52][53][54]. On the contrary, Orvin et al showed a slightly better performance of the MDRD than CG to predict mortality at one-year after acute coronary syndrome [13]. ...
Background
Renal dysfunction is associated with worse outcomes after primary percutaneous coronary intervention (PCI). However, whether glomerular filtration rate (GFR) estimated with various equations can equally predict outcomes after ST-Elevation Myocardial Infarction (STEMI) is still debated.
Methods
We compared the clinical impact of 3 different creatinine-based equations (Cockcroft and Gault (CG), CKD-epidemiology (CKD-EPI) and Full Age Spectrum (FAS)) to predict 1-year mortality in STEMI patients.
Results
Among 1755 consecutive STEMI patients who had undergone primary PCI included between 2006 and 2011, median estimated GFR was 79 (61;96) with the CG, 81 (65;95) with CKD-EPI and 75 (60;91) mL/min/1.73 m² with FAS equation. Reduced GFR values were independently associated with 1-year mortality risk with the 3 equations. Receiver operating curves (ROC) of CG and FAS equations were significantly superior to the CKD-EPI equation, p = 0.03 and p = 0.01, respectively. Better prediction with FAS and CG equations was confirmed by net reclassification index.
Conclusions
Our results suggest that in STEMI patients who have undergone primary PCI, 1-year mortality is better predicted by CG or FAS equations compared to CKD-EPI.
... The authors suggested that the MDRD equation, which we used, was the most consistent predictor of 5-year mortality. [35] The prevalence of decreased GFR that we observed in our study (19.6%) is similar to that reported in a Canadian study (18.6%), which included individuals aged ! 65 years and that used the MDRD equation and a single GFR estimation. ...
Background
Although a reduced glomerular filtration rate (GFR) in old people has been attributed to physiologic aging, it may be associated with kidney disease or superimposed comorbidities. This study aims to assess the prevalence of decreased GFR in a geriatric population in a developing country and its prevalence in the absence of simultaneous diseases.
Study design and methods
This is a cross-sectional study of data from the Saúde, Bem-Estar e Envelhecimento cohort study (SABE study[Health, Well-Being and Aging]), a multiple cohorts study. A multistage cluster sample composed of 1,253 individuals representative of 1,249,388 inhabitants of São Paulo city aged ≥60 years in 2010 was analyzed. The participants answered a survey on socio-demographic factors and health, had blood pressure measured and urine and blood samples collected. GFR was estimated and defined as decreased when <60 mL/min/1.73m². Kidney damage was defined as dipstick-positive hematuria or urinary protein:creatinine > 0.20 g/g.
Results
The prevalence of GFR <60 mL/min/1.73m² was 19.3%. Individuals with GFR <60 mL/min/1.73m² were older (75±1 versus 69±1 years, p<0.001), had lower schooling (18 versus 30% with complete 8-year basic cycle, p = 0.010), and higher prevalence of hypertension (82 versus 63%, p<0.001), diabetes (34 versus 26%, p = 0.021), cardiovascular disease (43 versus 24%, p<0.001) and kidney damage (35% versus 15%, p<0.001). Only 0.7% of the entire studied population had GFR <60 mL/min/1.73m² without simultaneous diseases or kidney damage. Among the individuals with GFR <60 mL/min/1.73m², 3.5% had neither renal damage nor associated comorbidities, whereas among those with GFR ≥60 mL/min/1.73m², 11.0% had none of these conditions. Logistic regression showed that older age, cardiovascular disease and hypertension were associated with GFR<60 mL/min/1.73m².
Conclusions
Decreased GFR was highly prevalent among the geriatric population in a megalopolis of a developing country. It was rarely present without simultaneous chronic comorbidities or kidney damage.
... This prospective cohort study shows that very simple clinical features, easily and collected routinely, are associated with a significantly higher risk of mortality at three months after discharge in non-oncologic patients, these were being permanently bedridden, eGFR ≪29 mL/min/1.73m 2 , albumin ≪ 2.5 g/dL, severe dementia with total or severe dependence and hospital admission in the previous six months. These data agree with previous observations (Ayaz, Sahin, & Sahin, 2014;Chung et al., 2015;Kagansky, Berner, & Koren- Morag, 2005;Mandelli, Riva, & Tettamanti, 2015; Mitchell, Table 1 Main characteristic of patients included in the study. ...
Background:
Short-term prognosis, e.g. mortality at three months, has many important implications in planning the overall management of patients, particularly non-oncologic patients in order to avoid futile practices. The aims of this study were: i) to investigate the risk of three-month mortality after discharge from internal medicine and geriatric wards of non-oncologic patients with at least one of the following conditions: permanent bedridden status during the hospital stay; severely reduced kidney function; hypoalbuminemia; hospital admissions in the previous six months; severe dementia; ii) to establish the absolute risk difference of three-month mortality of bedridden compared to non-bedridden patients.
Methods:
This prospective cohort study was run in 102 Italian internal medicine and geriatric hospital wards. The sample included all patients with three-months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during the whole hospital stay. The following parameters were also recorded: estimated GFR≤29mL/min/1.73m(2); severe dementia; albuminemia ≪2.5g/dL; hospital admissions in the six months before the index admission.
Results:
Of 3915 patients eligible for the analysis, three-month follow-up were available for 2058, who were included in the study. Bedridden patients were 112 and the absolute risk difference of mortality at three months was 0.13 (CI 95% 0.08-0.19, p≪0.0001). Logistic regression analysis also adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition (OR 2.10, CI 95% 1.12-3.94), severely reduced kidney function (OR 2.27, CI 95% 1.22-4.21), hospital admission in the previous six months (OR 1.96, CI 95% 1.22-3.14), severe dementia (with total or severe physical dependence) (OR 4.16, CI 95% 2.39-7.25) and hypoalbuminemia (OR 2.47, CI 95% 1.12-5.44) were significantly associated with higher risk of three-month mortality.
Conclusions:
Bedridden status, severely reduced kidney function, recent hospital admissions, severe dementia and hypoalbuminemia were associated with higher risk of three-month mortality in non-oncologic patients after discharge from internal medicine and geriatric hospital wards.
