Dr Elisa Bongetti1, 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
1Department 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. The University of Iowa, 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 whether the association between estimated glomerular filtration rate (eGFR) and health outcomes in adults aged ≥65 years differs depending on whether an older-age-validated equation or the 2021 Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI2021) eGFR equation is used.
Background:
Not all eGFR equations, including CKD-EPI2021, have been validated for use in older adults. Older-age-validated equations include the Berlin Initiative Study 1(BIS1), European Kidney Function Consortium (EKFC) and Full Age Spectrum (FAS). Older-age-validated equations result in reclassification of chronic kidney disease (CKD) stage in a significant proportion of individuals.
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. Baseline characteristics and long-term health outcomes were compared in participants reclassified from CKD-EPI2021 to a different CKD stage using an older-age-validated equation versus those with unchanged classification.
Results: 17,686 participants were included for analyses. Baseline eGFR decreased by a median of 14.8mL/min (IQR: 11.0,18.0) with BIS1, 13.9mL/min (IQR: 10.8,16.6) using FAS, and 11.8mL/min (IQR: 9.7,13.5) using EKFC. Prevalence of CKD was lowest using CKD-EPI2021 (21%, n=3,740) and highest using BIS1 (46%, n=8,097). Over a median follow-up period of 8.4 years (IQR:7.2,9.3), there was no difference in disability-free survival, mortality, physical disability, dementia or major cardiac events in reclassified, versus non-reclassified, participants.
Conclusions:
Implementing an older-age-validated equation would substantially lower eGFR, increasing the proportion of well, older Australian adults with CKD. There was no difference in long-term health outcomes among people reclassified to a different stage of CKD than people who remained in the same stage.
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