Nondisease-specific problems and all-cause mortality among older adults with CKD: the REGARDS Study.

Academic Article

Abstract

  • BACKGROUND AND OBJECTIVES: The term "nondisease-specific" has been used to describe problems that cross multiple domains of health and are not necessarily the result of a single underlying disease. Although individuals with reduced eGFR and elevated albumin-to-creatinine ratio have many comorbidities, the prevalence of and outcomes associated with nondisease-specific problems have not been well studied. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Participants included 3557 black and white United States adults ≥75 years of age from the Reasons for Geographic and Racial Differences in Stroke Study. Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Hazard ratios for mortality over a median (interquartile range) of 5.4 (4.2-6.9) years of follow-up associated with one, two, or three to six nondisease-specific problems were calculated and stratified by eGFR (≥60, 45-59, and <45 ml/min per 1.73 m(2)) and separately, albumin-to-creatinine ratio (<30, 30-299, and ≥300 mg/g). Secondary outcomes included hospitalizations and emergency department visits over 1.8 (0.7-4.0) and 2.3 (0.9-4.7) years of follow-up, respectively. RESULTS: The prevalence of nondisease-specific problems was more common at lower eGFR and higher albumin-to-creatinine ratio levels. Within each eGFR and albumin-to-creatinine ratio strata, the risk for mortality was higher among those with a greater number of nondisease-specific problems. For example, among those with an eGFR=45-59 ml/min per 1.73 m(2), the multivariable adjusted hazard ratios (95% confidence intervals) for mortality associated with one, two, or three to six nondisease-specific problems were 1.17 (0.78 to 1.76), 1.95 (1.24 to 3.07), and 2.44 (1.39 to 4.27; P trend <0.001). Risk for hospitalization and emergency department visits was higher among those with more nondisease-specific problems within eGFR and albumin-to-creatinine ratio strata. CONCLUSIONS: Among older adults, nondisease-specific problems commonly co-occur with reduced eGFR and elevated albumin-to-creatinine ratio. Identification of nondisease-specific problems may provide mortality risk information independent of measures of kidney function.
  • Keywords

  • CKD, epidemiology and outcomes, geriatric nephrology, African Americans, Age Factors, Aged, Aged, 80 and over, Albuminuria, Biomarkers, Cause of Death, Comorbidity, Creatinine, Emergency Service, Hospital, European Continental Ancestry Group, Geriatric Assessment, Glomerular Filtration Rate, Hospitalization, Humans, Kidney, Multivariate Analysis, Prevalence, Prognosis, Proportional Hazards Models, Renal Insufficiency, Chronic, Risk Factors, Time Factors, United States
  • Digital Object Identifier (doi)

    Author List

  • Bowling CB; Booth JN; Gutiérrez OM; Kurella Tamura M; Huang L; Kilgore M; Judd S; Warnock DG; McClellan WM; Allman RM
  • Start Page

  • 1737
  • End Page

  • 1745
  • Volume

  • 9
  • Issue

  • 10