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Older patients are less prone to fast decline of renal function: a propensity-matched study

  • Nephrology - Original Paper
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Abstract

Purpose

Despite CKD is common among older patients, and although factors associated with CKD progression have been explored over decades, little is known about the decline of renal function specifically in older individuals.

Methods

We included adult patients with CKD on conservative management in a propensity-score matched study 1:1 older (> 65 year) and young (≤ 65 yr). Factors associated with the slope of the decline of eGFR such as proteinuria, initial eGFR, diabetes, sex, and use of angiotensin-converting enzyme inhibitor/angiotensin receptor block (ACEI/ARB) were analyzed. Inclusion criteria were at least two consultations in the service and an initial eGFR lower than 45 ml/min/m2, in the period between January 2012 and December 2017.

Results

Crude analysis of eGFR decline shows a slower progression of older patients when compared to younger patients in both absolute change [− 2.0 (− 4.5, − 1.0) vs. -3.0 (− 7.0, − 1.0) ml/min/1.73m2, p < 0.001] and slope of eGFR reduction [− 2.2 (− 4.4, − 1.0) vs. 3.1 (− 6.7, − 1.2)) ml/min/1.73m2, p < 0.001]. Patients considered fast progressors (> 5 ml/min/1.73 m2/year decline in eGFR) were less likely to be older (35.2% young vs. 22.0% older, p < 0.001). Adjusted logistic multivariate regression confirmed that older patients had less odds ratio of eGFR decline, independently of the presence of proteinuria, diabetes, ACEI/ARB use, sex, baseline eGFR, baseline phosphate and baseline 25(OH) vitamin D.

Conclusion

Older patients present slower CKD progression even after multiple adjustments. This information should be taken into consideration while treating these patients on conservative management and should be kept in mind while planning dialysis start.

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Data availability

Data analyzed in the current study is available to authors upon reasonable request.

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Acknowledgements

We thank Fatima Libanio for extracting the data from electronic charts.

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Authors and Affiliations

  1. Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil

    Rosilene M. Elias

  2. LIM 16, Faculdade de Medicina da Universidade de São Paulo, Serviço de Nefrologia, Rua Dr. Enéas de Carvalho Aguiar 255, 7º Andar, São Paulo, SP, CEP, 05403-000, Brazil

    Paula M. R. Pina, Luis Carlos Arcon, Roberto Zatz, Rosa M. A. Moysés & Rosilene M. Elias

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Contributions

RME conceived the idea; PMRP and LCA collected the data; RZ, RMAM, and RME supervised the research; PMRP, RZ, RMAM and RME discussed and interpreted the results; RME analyzed the data; PMRP, RZ, and RME drafted the manuscript; All authors read and approved the final version.

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Correspondence to Rosilene M. Elias.

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Pina, P.M.R., Arcon, L.C., Zatz, R. et al. Older patients are less prone to fast decline of renal function: a propensity-matched study. Int Urol Nephrol 55, 3245–3252 (2023). https://doi.org/10.1007/s11255-023-03610-4

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