Dr Elisa Bongetti1,2, Professor Rory Wolfe3, Dr James Wetmore4, Dr Michael Ernst5, Dr Michelle Fravel5, Dr Anne Murray6, Dr Suzanne Orchard3, Dr Joanne Ryan3, Associate Professor Robyn Woods3, Professor Kevan Polkinghorne1,2,3
1Department of Nephrology, 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.
Background:
The clinical relevance of mild to moderately reduced eGFR in older adults, particularly in the absence of albuminuria, is challenging. Frailty is common in older adults and may cause reduced serum creatinine resulting in inadvertent over-estimation of GFR, further complicating kidney function assessment.
Aim:
To investigate whether two components of the frailty phenotype; gait speed or grip strength, may assist in identifying older adults with preserved or mild to moderately reduced eGFR at risk for health outcomes.
Methods:
Secondary analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) and the ASPREE-eXtension cohort, which enrolled independent, well, older adults aged ≥65 years in Australia and the United States. The association between eGFR (<60,60-79, ≥80mL/min/1.73m2) and gait speed (< or ≥1 meter per second) or grip strength (weak/not weak) with disability-free survival, all-cause mortality, physical disability or dementia was assessed using survival models.
Results:
16,925 participants were included for analyses with median follow-up if 8.4 years (IQR:2.7, 9.6). Mean age was 75.0 ± 4.5 years, and median eGFR was 79 mL/min (IQR:68, 89). In the presence of normal gait speed ≥1.0m/s or normal grip strength, modest reductions in eGFR did not confer risk for health outcomes. Reduced disability-free survival, death, and disability were increased in participants who had slow gait or weak grip, regardless of eGFR category. In participants with eGFR ≥80 mL/min/1.73m2, dementia risk was increased with slow gait (HR: 1.48, 95%CI1.23-1.79) or weak grip (HR:1.51, 95%CI:1.24-1.84).
Conclusion:
Gait speed and grip strength may assist in evaluating the clinical significance of variations in eGFR in community-dwelling older adults.
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