Nondisease-specific problems and all-cause mortality among older adults with CKD: The REGARDS study

Academic Article

Abstract

  • © 2014 by the American Society of Nephrology. 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 formortality 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 m2) 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 albuminto- 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 thosewith an eGFR=45–59 ml/min per 1.73 m2, 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 thosewithmore nondisease-specific problemswithin 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.
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    Author List

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

  • 1737
  • End Page

  • 1745
  • Volume

  • 9
  • Issue

  • 10