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Kravchenko G, Korycka-Bloch R, Stephenson SS, Kostka T, Sołtysik BK. Cardiometabolic Disorders Are Important Correlates of Vulnerability in Hospitalized Older Adults. Nutrients 2023; 15:3716. [PMID: 37686746 PMCID: PMC10490417 DOI: 10.3390/nu15173716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
With an increasingly aging population worldwide, the concept of multimorbidity has attracted growing interest over recent years, especially in terms of frailty, which leads to progressive multisystem decline and increased adverse clinical outcomes. The relative contribution of multiple disorders to overall frailty index in older populations has not been established so far. This study aimed to assess the association between the vulnerable elders survey-13 (VES-13) score, which is acknowledged to be one of the most widely used measures of frailty, and the most common accompanying diseases amongst hospitalized adults aged 60 years old and more. A total of 2860 participants with an average age of 83 years were included in this study. Multiple logistic regression with adjustment for age and nutritional status was used to assess the independent impact of every particular disease on vulnerability. Diabetes mellitus type 2, coronary artery disease, atrial fibrillation, heart failure, chronic kidney disease, osteoarthritis, fractures, eyes disorders, depression, dementia, pressure ulcers, and urinary incontinence were associated with higher scores of VES-13. Hospital admission of older subjects with those conditions should primarily draw attention to the risk of functional decline, especially while qualifying older patients for further treatment in surgery and oncology. At the same time, lipid disorders, gastrointestinal diseases, higher body mass index, and albumins level were related to a lower risk of being vulnerable, which may be attributed to a younger age and better nutritional status of those patients.
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Affiliation(s)
| | | | | | - Tomasz Kostka
- Department of Geriatrics, Healthy Aging Research Centre (HARC), Medical University of Lodz, Haller Sqr. No. 1, 90-647 Lodz, Poland; (G.K.); (R.K.-B.); (S.S.S.); (B.K.S.)
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Xia F, Hao W, Liang J, Zhao Z, Wu Y, Yu F, Hu W, Fang X, Liu W. Comparison of estimated glomerular filtration rate equations based on serum creatinine-, cystatin C- and creatinine-cystatin C in elderly Chinese patients. Int Urol Nephrol 2023; 55:943-952. [PMID: 36169900 DOI: 10.1007/s11255-022-03370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND This study aimed to further evaluate the accuracy of eleven GFR equations in different subgroups of an elderly Chinese hospitalized population. METHODS All participants of the study were divided into seven separate groups including age-subgroup, sex-subgroup, GFR Staging-subgroup and whether combined with diabetic, hypertensive, coronary heart disease (CHD) and cerebrovascular disease. Referring to Tc-99m-DTPA dual plasma sample clearance method, six serum creatinine (Cr)-based [Cockcroft-Gault (CG), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr), Lund-Malmö Revised (LMR), Berlin Initiative Study (BIS1), Full Age Spectrum (FASCr) and European Kidney Function Consortium (EKFC)], two serum cystatin C(Cys)-based (CKD-EPICys and FASCys), and three Cr-Cys combination based (CKD-EPICr-Cys, BIS2 and FASCr-Cys) equations were employed. Bias, interquartile range of the median difference (IQR), P30, and GFR misclassification rate were calculated to compare the performance of the selected equations. RESULTS A total of 359 elderly Chinese patients were enrolled. Overall, median mGFR was 36.91(25.26,56.32)ml/min/1.73 m2. Smaller biases (ml/min/1.73 m2) were shown in CKD-EPICr and BIS1 equations (0.75 and 0.61). IQR (ml/min/1.73m2) was least with BIS2 equation and FASCr-Cys equation (10.34 and 10.65). For accuracy (P30), performance of FASCr-Cys, BIS2, and BIS1 equation was superior (78.3%, 78.0%, and 74.7%, respectively). In terms of RMSE (ml/min/1.73 m2), BIS1 and FASCr-Cys equation performed better (12.44 and 12.51). CONCLUSIONS Overall, this study showed that the eGFR equations were less accurate in the diabetic and non-hypertension group than in the non-diabetic and hypertension group, respectively. Among all enrolled equations, the BIS2 and FASCr-Cys equations might be the best choice to evaluate glomerular filtration rate in Chinese elderly patients.
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Affiliation(s)
- Fangxiao Xia
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Wenke Hao
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Jinxiu Liang
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Zhi Zhao
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Yanhua Wu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Feng Yu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wenxue Hu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Xiaowu Fang
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wei Liu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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Suarilah I, Lin CC. Factors influencing self-management among Indonesian patients with early-stage chronic kidney disease: A cross-sectional study. J Clin Nurs 2021; 31:703-715. [PMID: 34405484 DOI: 10.1111/jocn.15930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to explore the self-management of patients with early-stage chronic kidney disease (CKD) and its influencing factors. METHODS A convenient sample of 226 patients with early-stage CKD was recruited from 63 Public Health Centers in Indonesia, from June to September 2020. Demographic characteristics, health literacy, illness perception, self-efficacy and self-management were assessed using self-reported questionnaires. Stepwise multiple linear regression analysis was performed to identify the factors influencing self-management. This study adhered to the EQUATOR checklist, STROBE. RESULTS The mean estimated glomerular filtration rate was 63.45 ml/min/1.73 m2 (standard deviation [SD] = 15.34). The average scores for health literacy, illness perception, self-efficacy and self-management were 32.11 (SD = 4.46), 4.57 (SD = 1.46), 183.64 (SD = 38.23) and 76.92 (SD = 9.45), respectively. The influencing factors were education level, monthly income, family history of comorbidity, health literacy and self-efficacy, which accounted for 45% of total self-management score. CONCLUSIONS Indonesian patients with early-stage CKD showed low level of health literacy, but positive illness perception and self-efficacy; these factors significantly affected CKD self-management. Health literacy was found to influence all dimensions of self-management: self-integration, problem-solving, seeking social support and adherence to the recommended regimen. RELEVANCE TO CLINICAL PRACTICE Adherence to the recommended regimen is the most challenging dimension of CKD self-management. Health literacy was found to be a major determinant of self-management. Improving health literacy and motivation of patients with early-stage CKD may help sustain positive illness perception and self-efficacy, and improve self-management.
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Affiliation(s)
- Ira Suarilah
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Chiu-Chu Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Chabala FW, Siew ED, Mutale W, Mulenga L, Mweemba A, Goma F, Banda N, Kaonga P, Wester WC, Heimburger DC, Aliyu MH, Munkombwe D. Prognostic model for nephrotoxicity among HIV-positive Zambian adults receiving tenofovir disoproxil fumarate-based antiretroviral therapy. PLoS One 2021; 16:e0252768. [PMID: 34252117 PMCID: PMC8274919 DOI: 10.1371/journal.pone.0252768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/22/2021] [Indexed: 11/19/2022] Open
Abstract
Persons living with HIV (PLWH) receiving tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) risk suffering TDF-associated nephrotoxicity (TDFAN). TDFAN can result in short- and long-term morbidity, including permanent loss of kidney function, chronic kidney disease (CKD), and end-stage kidney disease (ESKD) requiring dialysis. Currently, there is no model to predict this risk or discern which patients to initiate TDF-based therapy. Consequently, some patients suffer TDFAN within the first few months of initiating therapy before switching to another suitable antiretroviral or a lower dose of TDF. In a prospective observational cohort study of adult Zambian PLWH, we modelled the risk for TDFAN before initiating therapy to identify individuals at high risk for experiencing AKI after initiating TDF-based therapy. We enrolled 205 HIV-positive, ART-naïve adults initiating TDF-based therapy followed for a median of 3.4 months for TDFAN at the Adult Infectious Disease Research Centre (AIDC) in Lusaka, Zambia. We defined TDFAN as meeting any of these acute kidney disease (AKD) criteria: 1) An episode of estimated glomerular filtration rate (eGFR)< 60ml/ min/1.73m2 within 3 months, 2) reduced eGFR by> 35% within 3 months or 3) increased serum creatinine by> 50% within 3 months. A total of 45 participants (22%) developed acute kidney disease (AKD) after TDF-based therapy. The development of AKD within the first 3 months of commencing TDF-based therapy was associated with an increase in baseline serum creatinine, age, baseline eGFR and female sex. We concluded that baseline characteristics and baseline renal function biomarkers predicted the risk for AKD within the first 3-months of TDF-based therapy.
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Affiliation(s)
- Freeman W. Chabala
- Levy Mwanawasa Medical University, Institute of Basic and Biomedical Sciences, Lusaka, Zambia
- The University of Zambia, School of Medicine, Lusaka, Zambia
- * E-mail:
| | - Edward D. Siew
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Tennessee Valley Health Systems (TVHS), Veterans Affairs, Nashville, TN, United States of America
| | - Wilbroad Mutale
- The University of Zambia, School of Public Health, Lusaka, Zambia
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Lloyd Mulenga
- The University of Zambia, School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Aggrey Mweemba
- The University of Zambia, School of Medicine, Lusaka, Zambia
- The University Teaching Hospital, Lusaka, Zambia
| | - Fastone Goma
- The University of Zambia, School of Medicine, Lusaka, Zambia
| | | | - Patrick Kaonga
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
| | - William C. Wester
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- The University Teaching Hospital, Lusaka, Zambia
| | - Douglas C. Heimburger
- The University of Zambia, School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Muktar H. Aliyu
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Meharry Medical College School of Medicine, Nashville, TN, United States of America
| | - Derick Munkombwe
- The University of Zambia, School of Health Sciences, Lusaka, Zambia
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Acute kidney injury after nephrectomy: a new nomogram to predict postoperative renal function. BMC Nephrol 2020; 21:181. [PMID: 32410656 PMCID: PMC7227356 DOI: 10.1186/s12882-020-01839-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 05/04/2020] [Indexed: 12/15/2022] Open
Abstract
Background We aimed to develop a nomogram based on preprocedural features for early prediction of acute kidney injury (AKI) and to assess the prognosis in patients after radical and partial nephrectomy. Methods The study included a development cohort of 1111 patients who were treated between June 2012 and June 2017 and an additional validation cohort of 356 patients who were treated between July 2017 and June 2018. Stepwise regression and logistic regression analyses were used to evaluate the association between predictors and AKI. Incorporating all independent predictors, a nomogram for postoperative AKI was developed and externally validated. Patients were followed up for 5 years to assess renal function, acute kidney disease (AKD), chronic kidney disease (CKD), hospital readmission and mortality were key prognosis we focused on. Results After multivariate logistic regression, radical nephrectomy (odds ratio (OR) = 3.57, p < 0.001), aspirin (OR = 1.79, p = 0.008), systolic blood pressure (OR = 1.41, p = 0.004), triglyceride (OR = 1.26, p = 0.024), and alkaline phosphatase (OR = 1.75, p = 0.034) were independent risk factors for postoperative AKI, while albumin (OR = 0.72, p = 0.031) was a protective factor for postoperative AKI. Patients with a higher estimated glomerular filtration rate (eGFR) (60–90 ml/min/1.73 m2, OR = 0.41, p = 0.004; ≥ 90 ml/min/1.73 m2, OR = 0.37, p < 0.001) were less prone to AKI than those with a lower eGFR (< 15 ml/min/1.73 m2). These predictors were all included in the final nomogram. The area under the receiver operating characteristics curve for the model were 0.77 (p < 0.001) in the development cohort and 0.72 (p < 0.001) in the validation cohort. The incidence of AKD and CKD were 27.12 and 18.64% in AKI group, which were much higher than those in no AKI group (p < 0.001). Conclusions The nomogram had excellent predictive ability and might have significant clinical implications for the early detection of AKI in patients undergoing nephrectomy.
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Han Q, Zhang D, Zhao Y, Liu L, Li J, Zhang F, Luan F, Duan J, Liu Z, Cai G, Chen X, Zhu H. The practicality of different eGFR equations in centenarians and near-centenarians: which equation should we choose? PeerJ 2020; 8:e8636. [PMID: 32117641 PMCID: PMC7039118 DOI: 10.7717/peerj.8636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/26/2020] [Indexed: 11/20/2022] Open
Abstract
Background No studies have examined the practicality of the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations for the estimated glomerular filtration rate (eGFR) in a large sample of centenarians. We aim to investigate the differences among the equations and suggest the most suitable equation for centenarians and near-centenarians. Methods A total of 966 centenarians and 787 near-centenarians were enrolled, and the eGFR was calculated using the three equations mentioned above. Agreement among the equations was investigated with the κ statistic and Bland-Altman plots. Sources of discrepancy were investigated using a partial correlation analysis. Results The three equations for assessing eGFR are not considered interchangeable in centenarians and near-centenarians. Δ(MDRD, CKD-EPI) and Δ(MDRD, BIS1) increased with age, but Δ(CKD-EPI, BIS1) was relatively stable with age. Δ(MDRD, CKD-EPI) and Δ(MDRD, BIS1) were considerable in subjects with Scr levels less than 0.7 mg/dL and decreased with the Scr level. A considerable difference between CKD-EPI and BIS1 was observed for participants with Scr levels ranging from 0.5 to 1.5 mg/dL. This difference increased with Scr levels ranging from 0.5 to 0.7 mg/dL, was relatively stable for Scr levels ranging from 0.7 to 0.9 mg/dL, and decreased with Scr levels ranging from 0.9 to 1.5 mg/dL. The differences in the three comparisons were all greater in women than in men (p < 0.05). Conclusions We tend to suggest the MDRD equation to calculate the glomerular filtration rate (GFR) in elderly individuals >95 years old who have no risk factors for cardiovascular disease; the BIS1 equation to calculate the eGFR for elderly individuals younger than 94 years old who have risk factors for cardiovascular disease; the CKD-EPI equation to calculate the eGFR of elderly individuals with Scr levels greater than 1.5 mg/dL; and the BIS1 equation to calculate the eGFR of older women with Scr levels less than 0.7 mg/dL.
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Affiliation(s)
- Qiuxia Han
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.,School of Medicine, Nankai University, Tianjin, China.,The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology of Zhengzhou University, Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Dong Zhang
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Yali Zhao
- Central Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Liang Liu
- Management Department, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Jing Li
- Management Department, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Fu Zhang
- Management Department, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Fuxin Luan
- Management Department, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Jiayu Duan
- The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology of Zhengzhou University, Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Zhangsuo Liu
- The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology of Zhengzhou University, Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Guangyan Cai
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Xiangmei Chen
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Hanyu Zhu
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
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7
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Polkinghorne KR, Wolfe R, Jachno KM, Wetmore JB, Woods RL, McNeil JJ, Nelson MR, Reid CM, Murray AM. Prevalence of chronic kidney disease in the elderly using the ASPirin in Reducing Events in the Elderly study cohort. Nephrology (Carlton) 2019; 24:1248-1256. [PMID: 30663195 PMCID: PMC6812602 DOI: 10.1111/nep.13565] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 12/15/2022]
Abstract
AIM The prevalence of chronic kidney disease (CKD) in the elderly is controversial because age-related decline in kidney function may not truly reflect underlying kidney disease. We estimate the baseline prevalence and predictors of CKD using the CKD Epidemiology Collaboration (CKD-EPIeGFR ) and Berlin Initiative Study 1 (BIS1eGFR ) eGFR equations in the ASPirin in Reducing Events in the Elderly (ASPREE) trial cohort of healthy older participants. METHODS GFR was estimated using CKD-EPI and BIS1 equations. CKD was defined as eGFR <60 mL/min/1.73 m2 or ≥ 60 mL/min/1.73 m2 with urine albumin creatinine ratio (UACR) ≥ 3 mg/mmol. Logistic regression was used to identify predictors of CKD prevalence defined by each eGFR equation. RESULTS Data for analysis were complete for 17,762 participants. Mean age was 75.1 years (SD 5); 56.4% were female, 76.4% had hypertension, 9% had diabetes mellitus. Mean CKD-EPIeGFR was 73.0 (SD 14.2), compared with mean BIS1eGFR of 62.7 (11.4). Median UACR was 0.8 (IQR 0.5, 1.5) mg/mmol. Prevalence of CKD by CKD-EPIeGFR was 27% (predominantly due to normoalbuminuric stage 3a CKD), substantially lower than 47.1% by BIS1eGFR ; the difference was predominantly driven by reclassification of individuals from G1 and G2 CKD to stage G3a without albuminuria. Increased prevalence of CKD by either equation was related to older age, hypertension, diabetes, or higher body mass index. CONCLUSIONS Prevalence of CKD with CKD-EPIeGFR was 27%, and doubled using the elderly specific BIS1eGFR , with most participants reclassified from stage 2 to stage 3a. Increased prevalence of CKD was related older age, hypertension, diabetes, or increased body mass index.
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Affiliation(s)
- Kevan R Polkinghorne
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kim M Jachno
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - James B Wetmore
- Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota, USA
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Anne M Murray
- Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota, USA
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Houlind MB, Petersen KK, Palm H, Jørgensen LM, Aakjær M, Christrup LL, Petersen J, Andersen O, Treldal C. Creatinine-Based Renal Function Estimates and Dosage of Postoperative Pain Management for Elderly Acute Hip Fracture Patients. Pharmaceuticals (Basel) 2018; 11:E88. [PMID: 30231578 PMCID: PMC6160960 DOI: 10.3390/ph11030088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022] Open
Abstract
Many analgesics and their metabolites are renally excreted. The widely used Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated glomerular filtration rate (eGFR) equations are not developed for use in the elderly, while the recent Berlin Initiative Study (BIS), Full Age Spectrum (FAS), and Lund-Malmö revised (LMR) equations are. This observational study investigated differences between creatinine-based eGFR equations and how the choice of equation influences dosage of analgesics in elderly (≥70 years) patients admitted with acute hip fracture. eGFR was calculated by the CKD-EPI, BIS, Cockcroft-Gault (CG), FAS, LMR, and Modification of Diet in Renal Disease (MDRD) equations. Standard daily dose for postoperative pain medications ibuprofen, morphine and gabapentin was simulated for each equation according to dosage recommendations in Renbase®. For 118 patients, mean eGFR from the CKD-EPI, BIS, CG, FAS, LMR, and MDRD equations was 67.3 mL/min/1.73 m², 59.1 mL/min/1.73 m², 56.9 mL/min/1.73 m², 60.3 mL/min/1.73 m², 58.9 mL/min/1.73 m², and 79.1 mL/min/1.73 m², respectively (p < 0.0001). Mean difference to CKD-EPI was -10.4 mL/min/1.73 m² to 11.8 mL/min/1.73 m². Choice of eGFR equation significantly influenced the recommended dose (p < 0.0001). Shifting to BIS, FAS, or LMR equations led to a lower recommended dose in 20% to 31% of patients. Choice of eGFR equation significantly influenced dosing of ibuprofen, morphine, and gabapentin.
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Affiliation(s)
- Morten Baltzer Houlind
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark.
| | - Kristian Kjær Petersen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7, building A2-206, 9220 Aalborg Ø, Denmark.
| | - Henrik Palm
- Orthopedic Department, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark.
| | - Lillian Mørch Jørgensen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
| | - Mia Aakjær
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark.
| | - Lona Louring Christrup
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark.
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Enterance B, 2nd floor, 1014 København, Denmark.
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- Emergency Department, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 436, 2650 Hvidovre, Denmark.
| | - Charlotte Treldal
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark.
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