Prospective study of progression of kidney dysfunction in community-dwelling older adults.
OBJECTIVE
Few prospective studies have assessed renal dysfunction in older persons. We sought to define kidney dysfunction among a community-based cohort of elderly subjects and to determine the factors for its progression.


METHODS
The Epidemiologia do Idoso (EPIDOSO) Study is a prospective study of individuals > or =65 years old (mean 72.6 +/- 0.3), living in the community in the city of São Paulo. The creatinine clearance (CrCl) of 269 individuals of this cohort was estimated during 8 years of follow-up. The rate of decline in CrCl was calculated using linear regression analysis and dividing the group into tertiles of CrCl change.


RESULTS
Overall mean change in CrCl was -2.37 +/- 0.23 mL/min per year. Mean age increased with the greatest degree of decline in renal function (71.1 +/- 0.59, 72.5 +/- 0.54 and 74.3 +/- 0.58, for the first, second and third CrCl change tertiles, respectively, P < 0.01). A higher value of baseline CrCl was associated with progressive decline in CrCl (P < 0.01). Diastolic BP was greater in the second versus the first estimated glomerular filtration rate tertile (83 +/- 1 vs 80 +/- 1 mmHg, P < 0.05). High-density lipoprotein (HDL) cholesterol was inversely associated with CrCl decline (P < 0.05).


CONCLUSIONS
Progression of kidney dysfunction occurs in most community-dwelling elderly. Strategies aimed at slowing the progression should be considered for possible risk factors of older age, baseline CrCl, BP and HDL.
Sesso
Ricardo
R
Division of Nephrology, Department of Medicine, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil. rsesso@nefro.epm.br
Prado
Fernando
F
Vicioso
Belinda
B
Ramos
Luiz R
LR
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000375:Aging; D001794:Blood Pressure; D001938:Brazil; D008076:Cholesterol, HDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000503:physiopathology; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D008076:Cholesterol, HDL; D003404:Creatinine