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Old age is a positive modifier of renal outcome in Taiwanese patients with stages 3–5 chronic kidney disease

  • Yu-Hsiang Chou
  • Chung-Jen Yen
  • Tai-Shuan Lai
  • Yung-Ming ChenEmail author
Original Article
  • 9 Downloads

Abstract

Background

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.

Aims

We investigated the effect of age on outcome in a cohort with stages 3–5 CKD patients by age category.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Age Chronic kidney disease End-stage renal disease Mortality Competing risk analysis 

Notes

Acknowledgements

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.

Ethical standards

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.

Informed consent

No informed consent requirement was required by the Research and Ethics Committee of the National Taiwan University Hospital.

Supplementary material

40520_2018_1117_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 KB)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineNational Taiwan University Hospital Jin-Shan BranchNew Taipei CityTaiwan
  2. 2.Renal Division, Department of Internal Medicine, College of MedicineNational Taiwan University Hospital, National Taiwan UniversityTaipeiTaiwan
  3. 3.Department of Internal Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan

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