Dr Elisa Bongetti1,2, Professor Rory Wolfe3, Dr James Wetmore4, Dr Michael Ernst5, Associate Professor Michelle Fravel5, Dr Anne Murray6, Dr Suzanne Orchard3, Associate Professor Robyn Woods3, Professor Kevan Polkinghorne1,2,3
11. Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, Australia, 2Department of Medicine, Monash University, Melbourne, Australia, 3School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 4Division of Nephrology, Hennepin Healthcare, Minneapolis, USA, 5Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, Iowa City, USA, 6Berman Center for Outcomes and Clinical Research and Department of Medicine, Hennepin Healthcare Research Institute, and Department of Medicine, Geriatrics Division, Hennepin Healthcare , Minneapolis, USA
Biography:
Elisa is an early career nephrologist at Monash Health and a full time PhD candidate at Monash University. Her thesis examines long-term health outcomes associated with measures of kidney function in older adults.
Aim:
To assess the clinical impact of changing from the current definition for chronic kidney disease (CKD) to an older person age-adapted definition (estimated glomerular filtrate rate [eGFR] <45mL/min or evidence of kidney damage).
Background:
In older adults, mild to moderate reductions in eGFR, particularly in the absence of albuminuria, are not clearly associated with health outcomes.
Methods:
Secondary analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) randomised trial and the ASPREE-eXtension cohort, which enrolled independent, well, older adults aged ≥65 years in Australia and the United States. Adjusted survival analyses were undertaken to compare the association between eGFR (<45,45-59,60-89,≥90ml/min) and health outcomes using 2009 and 2021 Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI2009,CKD-EPI2021) and older-age-validated equations; Berlin Initiative Study 1 (BIS1), European Kidney Function Consortium (EKFC) and Full Age Spectrum (FAS).
Results:
17,686 participants were included for analyses. Changing to the age-adapted definition, absolute reduction in CKD prevalence was -9% with CKD-EPI2021, -13% using CKD-EPI2009, -31% with BIS1, -29% with FAS and -22% with EKFC. Over a median follow-up period of 8.4 years (IQR:7.2,9.3) there was no difference in disability-free survival, dementia, or physical disability in participants with eGFR <45 or 45-59mL/min compared to eGFR of 60-89mL/min using any equation. For all equations, mortality was increased for eGFR <45ml/min, but not 45-59ml/min. Major adverse cardiovascular events was higher with eGFR <45 for all equations, eGFR 45-59ml/min using EKFC (HR:1.21, 95%CI:1.07-1.37) and CKD-EPI2009 (HR:1.23, 95%CI:1.07-1.42).
Conclusions:
In older adults, well, community-dwelling older adults, changing to an age-adapted definition would result in a substantial reduction in the prevalence of diagnosed CKD. Risk for health outcomes for eGFR <45 and eGFR 45-59ml/min was comparable.
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