Among those lost to follow up, had died, were not found or had moved from the city, 21 were institutionalized and refused to participate in the continuation of the study.
They were assisted by a proxy respondent when they scored below The MMSE has thirteen items that are less dependent upon schooling because the South American elderly population as a whole has a low level of schooling. The following variables were obtained from the questionnaire: 1. The following anthropometric variables were considered: systolic and diastolic blood pressure mean of three measurements in the same visit, mmHg ; waist circumference cm , height m and weight kg measurements.
The dipstick was read manually by a trained professional following instructions provided by the manufacturer. Uri-Color check. Descriptive analysis was carried out. Categorical data are presented as weighted percentages, and continuous variables, as weighted means and standard errors.
The survey package from the R 2. The results are expressed as weighted values. A backward stepwise logistic regression was performed using the survey-weighted generalized linear models svyglm package , with inverse-probability weighting and design-based standard errors. The Wald test was used to evaluate the statistical significance of the association between independent and dependent variables. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model. Of the individuals answering the questionnaire, had their blood collected and entered the study to detect decreased GFR representative of a population of 1,, individuals , and of them had their urine collected and were evaluated for renal damage representative of , individuals.
There were no differences between the individuals with and without blood collection. In the comparison of individuals with and without urine collection they were also similar, except that those without urine samples were slightly older The individuals were predominantly women Most of them went to school Although public health insurance is universal in Brazil, Forty nine percent perceived their health as good or very good, and Among those not reporting hypertension, Among those not reporting diabetes, only 3.
The prevalence of metabolic syndrome was A normal BMI was found in Mean GFR was Gender, ethnic background, BMI, income, access to private health insurance, perception of health as good or very good and smoking status were similar in both groups.
The prevalence of hypertension, diabetes and cardiovascular disease were higher in the decreased GFR group Table 1. The prevalence of hypertension from The prevalence of metabolic syndrome decreased with age The prevalence of individuals without any of these diseases was similar in all groups A sharp increase in the prevalence of decreased GFR was observed with aging: Data are presented as weighed percentages.
Cardiovascular disease: self-reported. None: absence of hypertension, diabetes, metabolic syndrome or cardiovascular disease. The decreased GFR group showed lower levels of hemoglobin Phosphorus, albumin, CRP and ferritin were similar in both groups. The frequency of renal damage increased with the decrease of GFR: Considering the entire population, only 9. Comorb: comorbidities. The logistic regression showed that increasing age and presence of hypertension or cardiovascular disease were associated with decreased GFR.
Table 2. Glomerular filtration rate decreases with aging, but studies examining whether this process is physiological or pathological have yielded conflicting results. We showed that only 0. However, both increased age and presence of comorbidities were independent factors associated with decreased GFR. These data suggest that a finding of a decreased GFR in elderlies is frequently associated to a pathological condition instead of only a normal aging process.
Epidemiological population-based data on CKD prevalence are scarce, particularly in low and middle-lower income countries where the elderly population is increasing, as is the prevalence of diabetes, hypertension and obesity. The major risk factors for CKD were obesity or overweight, diabetes, hypertension and dyslipidemia. The few population—based studies designed specifically to assess the elderly population have shown great diversity with respect to CKD prevalence, ranging from The authors suggested that the MDRD equation, which we used, was the most consistent predictor of 5-year mortality.
We observed a higher prevalence of decreased GFR than two other population-based Brazilian studies. This discrepancy may be partially explained by the characteristics of the two populations: age Our study has some limitations. However, the laboratory methods used in the present study are the most used methods for SCr and proteinuria dosage in our country and thus our data represent what the doctors in Brazil have to deal with.
Volume Article Contents Abstract. Subjects and methods. Impact of age on glomerular filtration estimates. Pierre Douville , Pierre Douville. Oxford Academic. Ariane R. Jean Talbot. Simon Desmeules. Serge Langlois. Mohsen Agharazii.
Select Format Select format. Permissions Icon Permissions. Abstract Background. Cohort A outpatients with completed h creatinine clearance. Cohort B ambulatory patients from non-hospital based clinic with normal serum creatinine. Number Age Open in new tab. However, it is known that the contribution of tubular secretion increases as the GFR declines [ 10 ]. Therefore, a greater correction is necessary for patients with renal insufficiency. Therefore, we applied this relationship rather than a fixed factor to correct for tubular secretion.
Table 2 Equations used for eGFR. Open in new tab Download slide. Distribution of creatinine in cohort B. Age changes in glomerular filtration rate, effective renal plasma flow and tubular excretory capacity in adult males. Google Scholar Crossref. Search ADS. Kidney Disease Outcome Quality Initiative. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation.
A simplified equation to predict glomerular filtration rate from serum creatinine. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Limitations of creatinine as a filtration marker in glomerulopathic patients. Serum creatinine as an index of renal function: new insights into old concepts. Google Scholar PubMed. Assessing kidney function—measured and estimated glomerular filtration rate.
Prevalence of chronic kidney disease and decreased kidney function in the adult US population: third National Health and Nutrition Examination Survey.
Age dependence of renal function: clearance of iohexol and p-amino hippurate in healthy males. Reference data for 51 Cr-EDTA measurements of the glomerular filtration rate derived from live kidney donors. Prediction of relative glomerular filtration rate in adults: new improved equations based on Swedish Caucasians and standardized plasma-creatinine assays.
A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. Predictive performance of renal function equations for patients with chronic kidney disease and normal serum creatinine levels. All rights reserved. For Permissions, please e-mail: journals. Issue Section:. Download all slides. Comments 0. Add comment Close comment form modal. I agree to the terms and conditions. You must accept the terms and conditions. Add comment Cancel.
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More on this topic Serum creatinine is a poor marker of GFR in nephrotic syndrome. The renal tolerance of low-dose adefovir dipivoxil by lamivudine-resistant individuals co-infected with hepatitis B and HIV.
Related articles in Web of Science Google Scholar. Citing articles via Web of Science The management of membranous nephropathy — an update. Long-term survival benefit from dual kidney transplantation using kidneys from donors with very extended criteria - A French cohort between and The median absolute loss of eGFR decreased slightly with age while the median relative loss of eGFR increased slightly with age.
Since data from the year follow-up were available for 3, participants, we also determined eGFR in this subgroup. Decline of eGFR continued over the second 5 year period supplementary Fig. However, the proportion of individuals with rapid decline, i. Change in eGFR over the 5-year follow-up. A Absolute change in eGFR. This indicates that random intra-individual variations of creatinine had a greater effect after 5 years than after 10 years.
We have also calculated eGFR by a novel equation proposed by Pottel et al. While the results are very similar with a correlation coefficient of 0. Factors associated to loss of eGFR. We determined a broad spectrum of clinical and laboratory baseline characteristics of the study sample related to cardiovascular function, metabolism, renal function and others.
These are summarized in Table 2. In a first step associations with absolute decline in eGFR were analyzed in the whole cohort Fig. It should be noted here that in this exploratory analysis p-values indicated in the figure are considered as indicators of the potential relevance of these associations rather than as simple significances.
When crude data were analyzed numerous factors were associated with the change in eGFR in men and women over the observation period of 5 years.
After full adjustment several associations remained. Besides age and sex which are part of the CKD-EPI equation and may therefore be subject to confounding, several strong associations with substantial beta-estimates were found.
Systolic blood pressure SBP had the next largest negative beta-estimate i. It should be noted though that this was only observed after adjustment, including adjustment for SBP. Forest plot for variables affecting absolute change in eGFR over 5 years. A Crude and fully adjusted data for the whole cohort. Linear regression was adjusted for age, sex and all variables listed.
B Data for men and women adjusted for age and all variables listed. Regression coefficients beta for each variable are depicted for males and females with the corresponding p-value.
They refer to a 1 SD change in the respective variable with the exception of age, sex and the presence of albuminuria. If data were log-transformed before analysis this is indicated by log. Augmentation index AI as an indicator of arterial stiffness was associated with a greater decline in eGFR only in the crude model. After adjustment the p-value increased to 0. Another indicator of obesity, i. Among biomarkers higher serum albumin and uric acid concentrations unexpectedly were strongly associated to a lesser decline in eGFR both in the crude and adjusted model.
HDL-cholesterol and HbA1c were not associated with a lesser decline in the crude model but became significant after adjustment. When the data were analyzed separately for both sexes, the majority of associations remained significant in both sexes. The association of albuminuria with decline of eGFR was stronger in men than in women.
For HbA1c and CRP the associations remained only significant for women or men, respectively, while the other sex did not show any trend. Since it has been reported that the effect of risk factors for loss of eGFR may be age associated 20 we analyzed the interaction of the factors included in our study with age. There was only one significant interaction for HbA1c which changed the association of HbA1c with slower decline of eGFR in younger participants to faster decline in older participants supplementary Fig.
Recalculation of the data with the equation proposed by Pottel et al. Similarly, recalculation of the data without normalization to body surface area BSA did not change the association of risk factors with the rate of loss of eGFR data not shown.
To analyze associations in more depth we excluded all patients who took diuretics, antihypertensives, antidiabetics, or lipid lowering medications. The remaining 3, study participants Table 3 were analyzed in the same way as the whole cohort Fig. While most associations remained, HbA1c was now strongly associated with a lesser decline of eGFR in this selected subgroup. Due to the relatively small number of individuals with albuminuria 75 men and 38 women confidence intervals for albuminuria were comparably large.
In women there was no association of albuminuria with loss of eGFR. Otherwise, there were again no relevant sex differences. Again, recalculation with the alternative equation supplementary figs. Forest plot for variables affecting absolute change in eGFR in study participants who were not on antihypertensive, antidiabetic or lipid lowering medications. We present an analysis of determinants for the age dependent decline of GFR in a German cohort representative for the general population of Western Germany.
The strength of our study is the large size of the population based study cohort and the broad spectrum of clinical and biochemical phenotypes available. Our study confirms and extends previous data. In some cases we observed differences to published data. Overall, eGFR declined by approx. This is in line with recent findings on kidney function in healthy elderly individuals 21 and proposals for an age-adapted definition of CKD 6.
Baseline factors associated most strongly with a more rapid decline of eGFR in our cohort, i. It should be noted that the beta-estimate refers to 1 SD change of the independent quantitative variables which may have different clinical implications depending on the variable. These associations were also observed in the subgroup of individuals without medications.
WBC count showed a weak association with greater decline of GFR only in the whole group while in the medication free group this association was lost in the fully adjusted model. Factors associated with a lesser than average decline of eGFR were serum albumin, serum uric acid, and diastolic blood pressure. SBP has been described in most previous studies as risk factor for an increased rate of decline of eGFR 22 , 23 , 24 , 25 , In our study SBP had consistently the highest absolute beta-estimate of all risk factors analyzed except albuminuria in the whole sample, the subsample without medication, and in both sexes.
This was again the case for both sexes and also for the subsample without medication. This observation appeared surprising at first glance, but has been observed previously. Hirayama et al. This suggests that in persons with arterial hypertension a large pulse pressure, i. This is also compatible with the previously reported association of pulse pressure with eGFR decline This might indicate that arterial stiffness with loss of elasticity and increased amplitude of blood pressure is a relevant factor which might explain the inverse relation of DBP and loss of eGFR.
Indeed, in the whole cohort and the subgroup without medication an increased AI was associated with greater decline of eGFR in the crude data. These data show that while blood pressure is a key determinant for eGFR loss, its interaction with renal function is complex and may be modified by so far unidentified confounders. Decreased left ventricular function was a strong predictor of faster decline in eGFR in both sexes. It has been previously shown in a cross-sectional community based study that eGFR is associated with several measures of left ventricular function We extend this finding now by showing that also the rate of eGFR decline is greater in persons with impaired systolic or diastolic left ventricular function at baseline.
This underscores the relevance of the interaction between cardiac and renal function. After adjustment, endothelial function had neither in the whole group nor in the group without medication any association with the rate of decline of eGFR.
Another relevant finding of this study was the lack of association of eGFR decline with glycated hemoglobin in the whole cohort. Of all variables analyzed only HbA1c showed a strong interaction with age. While it was associated with slower loss of eGFR in participants younger than 55 years, it was associated with more rapid loss of eGFR in participants older than 55 years supplementary Fig.
Another major difference between the whole group and the medication-free group is the prevalence of diabetes 7. This indicates that the inverse association of HbA1c with eGFR decline is limited to persons without diabetes.
Our results are in contrast to some but not all other studies. Furthermore, since we did not differentiate between participants with overt and incipient diabetes in this analysis, this observation might be related to the initial hyperfiltration observed in diabetic individuals. Also parameters of lipid metabolism, i. GFR in our population was calculated rather than measured directly.
Another limitation is the availability of only two creatinine determinations at baseline and 5-year follow-up. Thus, random intra-individual variations of creatinine may have a significant effect on eGFR.
Preliminary data from the year follow-up support this assumption, but they also show that overall loss of eGFR continues at the same pace. The Gutenberg Health Study GHS is a population-based, observational, prospective, single-center cohort study in the Rhein-Main region in Germany with 15, participants recruited between April and March The sample was drawn randomly from the local registry offices in the City of Mainz and the adjacent District of Mainz-Bingen with a total population of approx.
Persons between 35 and 74 years of age were enrolled which represent about half of the total population. The sample was stratified for sex and residence urban and rural and in equal strata for decades of age.
Every participant underwent a comprehensive, standardized 5-h clinical investigation including among others anthropometric measurements, assessment of cardiovascular function, i. Participants were asked for their current medications which were classified according to ATC-codes. Details of the study protocol have been described previously 31 , All participants were invited for a follow-up visit after 5 years.
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