Old age is a positive modifier of renal outcome in Taiwanese patients with stages 3–5 chronic kidney disease
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The incidence of end-stage renal disease (ESRD) is increasing in elderly patients with chronic kidney disease (CKD). This contradicts the general notion that elderly people are more likely to die than to ever reach ESRD. And racial disparity in relation to age on kidney disease outcomes has always been a subject of research interest.
We investigated the effect of age on outcome in a cohort with stages 3–5 CKD patients by age category.
A total of 430 patients with a mean age of 65.6 years were enrolled and followed till death, ESRD, or end of 2015. Multivariable Cox regression was used to identify predictors of all-cause mortality. Competing risk-adjusted Cox regression was used to identify determinants of ESRD. The median follow-up was 7.3 (interquartile range 8.8) years.
Cox regression showed old age and low mean arterial pressure were predictors of mortality before and after onset of ESRD. Competing risk analysis revealed patients aged 20–39 years and 40–64 years exhibited greater risks of ESRD, compared to those aged over 75 years. These effects of age on outcomes occurred independently of traditional risk factors such as low estimated glomerular filtration rate and high proteinuria.
Age over 75 years is associated with decreased risk for ESRD even after adjustment for competing mortality. Given the global trends in population aging, there is a need to develop age-specific strategies, on top of the existing stage-based measures, to optimize the management of CKD in the elderly.
KeywordsAge Chronic kidney disease End-stage renal disease Mortality Competing risk analysis
The authors acknowledge statistical assistance provided by the Center of Statistical Consultation and Research in the Department of Medical Research, National Taiwan University Hospital. This study was supported in part by grants from the National Taiwan University Hospital (105-003126), the Ta-Tung Kidney Foundation, and the Mrs Hsiu-Chin Lee Kidney Research Fund, Taipei, Taiwan.
Compliance with ethical standards
Conflict of interest
All authors have no conflict of interest to declare.
This study was approved by the Research and Ethics Committee of the National Taiwan University Hospital.
Statement of human and animal rights
The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.
No informed consent requirement was required by the Research and Ethics Committee of the National Taiwan University Hospital.
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