title: Nondisease-specific problems and all-cause mortality among older adults with CKD: the REGARDS Study.
abstract: OBJECTIVE
  The term "nondisease-specific" has been used to describe problems that cross multiple domains of health and are not necessarily the result of a single underlying disease. Although individuals with reduced eGFR and elevated albumin-to-creatinine ratio have many comorbidities, the prevalence of and outcomes associated with nondisease-specific problems have not been well studied.
  
  
  METHODS
  Participants included 3557 black and white United States adults ≥75 years of age from the Reasons for Geographic and Racial Differences in Stroke Study. Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Hazard ratios for mortality over a median (interquartile range) of 5.4 (4.2-6.9) years of follow-up associated with one, two, or three to six nondisease-specific problems were calculated and stratified by eGFR (≥60, 45-59, and <45 ml/min per 1.73 m(2)) and separately, albumin-to-creatinine ratio (<30, 30-299, and ≥300 mg/g). Secondary outcomes included hospitalizations and emergency department visits over 1.8 (0.7-4.0) and 2.3 (0.9-4.7) years of follow-up, respectively.
  
  
  RESULTS
  The prevalence of nondisease-specific problems was more common at lower eGFR and higher albumin-to-creatinine ratio levels. Within each eGFR and albumin-to-creatinine ratio strata, the risk for mortality was higher among those with a greater number of nondisease-specific problems. For example, among those with an eGFR=45-59 ml/min per 1.73 m(2), the multivariable adjusted hazard ratios (95% confidence intervals) for mortality associated with one, two, or three to six nondisease-specific problems were 1.17 (0.78 to 1.76), 1.95 (1.24 to 3.07), and 2.44 (1.39 to 4.27; P trend <0.001). Risk for hospitalization and emergency department visits was higher among those with more nondisease-specific problems within eGFR and albumin-to-creatinine ratio strata.
  
  
  CONCLUSIONS
  Among older adults, nondisease-specific problems commonly co-occur with reduced eGFR and elevated albumin-to-creatinine ratio. Identification of nondisease-specific problems may provide mortality risk information independent of measures of kidney function.
authors.affiliation: Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Atlanta, Georgia; Departments of Medicine and cbbowli@emory.edu.
authors.forename: C Barrett
authors.initials: CB
authors.lastname: Bowling
authors.affiliation: Departments of Epidemiology.
authors.forename: John N
authors.initials: JN
authors.lastname: Booth
authors.affiliation: Departments of Epidemiology, Medicine.
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.affiliation: Geriatric Research, Education, and Clinical Center and Division of Nephrology, Department of Veterans Affairs, Palo Alto, California; and.
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.affiliation: Departments of Epidemiology.
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.affiliation: Health Care Organization and Policy, and.
authors.forename: Meredith
authors.initials: M
authors.lastname: Kilgore
authors.affiliation: Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama;
authors.forename: Suzanne
authors.initials: S
authors.lastname: Judd
authors.affiliation: Medicine.
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.affiliation: Departments of Medicine and Epidemiology, Emory University, Atlanta, Georgia;
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
authors.affiliation: Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.affiliation: Departments of Epidemiology.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000208:ethnology / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D004636:Emergency Service, Hospital; D015577:Geriatric Assessment; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: CKD; epidemiology and outcomes; geriatric nephrology