title: Declining Estimated Glomerular Filtration Rate and Its Association with Mortality and Comorbidity Over 10 Years in Elderly Women.
abstract: OBJECTIVE
  Renal function deteriorates with age, but a few studies have addressed this longitudinally in elderly women. Our objective was, using 5 estimated glomerular filtration rates (eGFR)-equations, to evaluate changes in renal function and association with adverse outcomes for a decade in 75-year-old women.
  
  
  METHODS
  Plasma creatinine was measured at ages 75 (n = 1,011), 78 (n = 827), 80 (n = 689) and 85 (n = 363). Glomerular filtration rates were estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI); Modification of Diet in Renal Disease (MDRD); revised Lund-Malmö (LM-rev); Berlin Initiative Study 1 (BIS1) and Cockcroft-Gault/body surface area (CG/BSA) equations. Mortality and comorbidity were investigated in women with chronic kidney disease (CKD) stage 3A and 3B-5.
  
  
  RESULTS
  Approximately, 95% of women had eGFR indicating CKD stage 2-3 and progression towards stage 3 was continuous. The women lost 22% of their eGFR during follow-up and loss accelerated between 80 and 85. Mean loss per decade was 16.6 ml/min/1.73 m(2). Women in CKD stage 3B-5 had an adjusted hazard ratio for death of 3.5 (95% CI 2.1-5.8) compared to stage 1-2 during follow-up and increased risk of diabetes, heart failure and hypertension. The CG/BSA, BIS1 and LM-rev equations continuously predicted lower eGFR than the MDRD and CKD-EPI equations.
  
  
  CONCLUSIONS
  eGFR in women aged 75-85 ranges from 30 to 89 ml/min/1.73 m(2) (stage 2-3). Decline was 16.6 ml/min/1.73 m(2) per decade; accelerated with age and appeared nonlinear. Women with CKD 3B-5 demonstrate an over 3-fold risk of death. eGFR <45 ml/min/1.73 m(2) was associated with mortality, confirming the new KDIGO classification 3A and 3B, as clinically applicable in the elderly.
authors.affiliation: Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
authors.forename: Linnea
authors.initials: L
authors.lastname: Malmgren
authors.forename: Fiona E
authors.initials: FE
authors.lastname: McGuigan
authors.forename: Sofia
authors.initials: S
authors.lastname: Berglundh
authors.forename: Kerstin
authors.initials: K
authors.lastname: Westman
authors.forename: Anders
authors.initials: A
authors.lastname: Christensson
authors.forename: Kristina
authors.initials: K
authors.lastname: Åkesson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000254:growth & development* / Q000473:pathology*; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D010024:Osteoporosis / Q000453:epidemiology; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology
chemical_list: D003404:Creatinine