Spectrum (characteristics) of patients with chronic kidney disease (CKD) with increasing age in a major metropolitan renal service

Mahmood, Usman , Healy, Helen G , Kark, Adrian , CAMERON, Anne Maree, Wang, Zaimin, Abeysekera, Rajitha and Hoy, Wendy E. (2017) Spectrum (characteristics) of patients with chronic kidney disease (CKD) with increasing age in a major metropolitan renal service. BMC Nephrology, 18 372: 1-10. doi:10.1186/s12882-017-0781-5


Author Mahmood, Usman
Healy, Helen G
Kark, Adrian
CAMERON, Anne Maree
Wang, Zaimin
Abeysekera, Rajitha
Hoy, Wendy E.
Title Spectrum (characteristics) of patients with chronic kidney disease (CKD) with increasing age in a major metropolitan renal service
Journal name BMC Nephrology   Check publisher's open access policy
ISSN 1471-2369
Publication date 2017-12-28
Year available 2017
Sub-type Article (original research)
DOI 10.1186/s12882-017-0781-5
Open Access Status DOI
Volume 18
Issue 372
Start page 1
End page 10
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Subject 2727 Nephrology
Abstract Aim of our study is to describe, in people with CKD, the demographic and clinical characteristics and outcomes with increasing age. The prevalence of CKD in Western populations, where longevity is the norm, is about 10-15%, but how age influence different characteristics of patients with CKD is largely not known.

One thousand two hundred sixty-five patients enrolled in the CKD.QLD registry at the Royal Brisbane and Women's Hospital were grouped according to age at consent i.e. <35, 35-44, 45-54, 55-64, 65-74, 75-84, 85+ years age groups, and were followed till start of renal replacement therapy (RRT), death, discharge or the censor date of September 2015.

Age ranged from 17.6 to 98.5 years with medians of 70.1 and 69.9 years for males and females respectively: 7% were <35 years of age, with the majority (63%) >65 years old. The leading renal diagnoses changed from genetic real disease (GRD) and glomerulonephritis (GN) in the younger patients to renovascular disease (RVD) and hypertension (HTN) in older patients. With increasing age, there were often multiple renal disease diagnoses, more advanced stages of CKD, greater number of comorbidities, more frequent and more costly hospitalizations, and higher death rates. The rates of initiation of renal replacement therapy (RRT) rose from 4.5 per 100 person years in those age < 35 years to a maximum of 5.5 per 100 person years in 45-54 years age group and were lowest, at 0.5 per 100 person years in those >85 years. Mortality rates increased by age group from 1.3 to 17.0 per 100 person years in 35-44 year and 85+ year age groups respectively. Rates of hospitalization, length of stay and cost progressively increased from the youngest to eldest groups. Patients with diabetic nephropathy had highest incidence rate of RRT and death. The proportion of patients who lost more than 5mls/min/1.73m2 of eGFR during at least 12 months follow up increased from 13.3% in the youngest age group to 29.2% in the eldest.

This is the first comprehensive view, with no exclusions, of CKD patients seen in a public renal specialty referral practice, in Australia. The age distribution of patients encompasses the whole of adult life, with a broader range and higher median value than patients receiving RRT. Health status ranged from a single system (renal) disease in young adults through, with advancing age, renal impairment as a component of, or accompanying multisystem diseases, to demands and complexities of support of frail or elderly people approaching end of life. This great spectrum demands a broad understanding and capacity of renal health care providers, and dictates a need for a wider scope of health services provision incorporating multiple models of care.
Keyword Age distribution
CKD.QLD registry
Chronic kidney disease
Clinical characteristics
Death
Heterogeneity
Hospitalization
Outcomes
Progression
Renal replacement therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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Created: Tue, 02 Jan 2018, 11:57:48 EST by Wendy E Hoy on behalf of UQ Centre for Clinical Research