Chronic kidney disease in the elderly: Understanding outcomes and patterns of kidney function decline towards individualized care


Josefina Santos
Nephrologist

 

Josefina Santos is Specialist of Nephrology and integrates as a researcher the Nephrology, Dialysis and Transplantation  of the Multidisciplinary Biomedical Research Unit of Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto. She obtained the PhD in Medical Sciences at ICBAS –UP in may of 2021, under the supervision of Prof. Luísa Lobato.

The optimal management of the knowledge required to make critical and shared decisions throughout the entire chronic kidney disease (CKD) continuum is extremely relevant to improve patient-centered care and outcomes in the elderly CKD population.

Research studies in this thesis included four cohorts of CKD patients aged 65 and older the Department of Nephrology of CHUPorto. Elderly CKD patients newly referred to the Department had a higher cardiovascular (CV) disease burden, contributing to the risk of mortality outweighing the risk of developing end-stage kidney disease (ESKD). Using a competing-risk approach, we showed that peripheral vascular disease increased the incidence of ESKD but did not increase pre-ESKD mortality, potentially representing a marker of renal function decline. A modified lson comorbidity index ≥5 increased the hazard for death, but not for dialysis initiation. Conservative management may be a therapeutic option in these patients, considering the likelihood of death before dialysis.

Four distinct s of eGFR decline before dialysis were identified, with impact on pre-ESKD care and mortality risk after dialysis.

A prognostic score to predict 6-month mortality after dialysis was developed and independently validated, with identification of five independent predictors: age of 75 years or older, coronary artery disease, cerebrovascular disease with hemiplegia, time of nephrology care before dialysis, and serum albumin levels. This represents a simple tool that can be applied in daily practice to guide patient care.

In elderly patients with stage 4 CKD, cystatin C-based eGFR was shown to be a better predictor of all-cause mortality in the first year, CV events, and admissions than creatinine-based eGFR, and may be helpful in clinical decision making.