title: Progression of kidney disease in elderly stage 3 and 4 chronic kidney disease patients.
abstract: OBJECTIVE
  The prevalence of chronic kidney disease (CKD) has been rising steadily in the elderly population. We studied the rate of progression of CKD in this population and the factors associated with progression of CKD to better identify patients who are likely to progress to ESRD.
  
  
  METHODS
  This was an observational study including 4562 patients older than 65 years with two outpatient estimated glomerular filtration rates (eGFRs) of <60 ml/min/1.73 m2, at least 90 days apart with no intervening eGFR >60 ml/min/1.73 m2(March 1, 2001, and March 31, 2008) at VA healthcare facilities. Patients with eGFR <15 ml/min/1.73 m2were excluded. Annual rate of decline of eGFR was studied and categorized as <1 ml/min/1.73 m2, 1-4 ml/min/1.73 m2, and >4 ml/min/1.73 m2.
  
  
  RESULTS
  Mean age of the study participants was 77.2 years. 24.3% were diabetics. 4.3% had proteinuria. In univariate comparison of different rates of progression, 54.2% patients had an annual rate of progression of <1 ml/min/1.73 m2. Multivariable mixed model analyses revealed that increasing age, body mass index, presence of cardiovascular disease, diabetes mellitus, and proteinuria were associated with significantly increased rate of progression of CKD. Serum albumin and hemoglobin level were inversely associated with progression of CKD.
  
  
  CONCLUSIONS
  CKD progresses at a slower rate in the elderly population. We have identified risk factors associated with an increased risk of progression of CKD in the elderly. This may help to improve health care planning and resource utilization.
authors.affiliation: Division of Nephrology, VAMC, Richmond, VA, USA.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Arora
authors.affiliation: Department of Biostatistics, SUNY at Buffalo, Buffalo, NY, USA.
authors.forename: Kabir
authors.initials: K
authors.lastname: Jalal
authors.affiliation: Department of Medicine, SUNY at Buffalo, Buffalo, NY, USA.
authors.forename: Anu
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Biostatistics, SUNY at Buffalo, Buffalo, NY, USA.
authors.forename: Randolph L
authors.initials: RL
authors.lastname: Carter
authors.affiliation: Department of Medicine, SUNY at Buffalo, Buffalo, NY, USA. James.Lohr@va.gov.|Buffalo VA Medical Center, 3495 Bailey Ave., Buffalo, NY, 14215, USA. James.Lohr@va.gov.
authors.forename: James W
authors.identifier: http://orcid.org/0000-0002-1585-9219
authors.initials: JW
authors.lastname: Lohr
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D011507:Proteinuria / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology*; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D014481:United States / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin
keywords: Chronic kidney disease; Elderly; Outcomes; Progression