ANALYZING KIDNEY IMPAIRMENT IN THE ELDERLY V. Guerrero, R. Sander, - - PowerPoint PPT Presentation

ANALYZING KIDNEY IMPAIRMENT IN THE ELDERLY

• V. Guerrero, R. Sander, A. Narvión, A. Sanjoaquín, J. Galindo, R. Quílez

University of Zaragoza

CONFLICT OF INTEREST DISCLOSURE

We have no potential conflict of interest to report

INTRODUCTION

The Chronic Kidney disease (CKD) has a high prevalence in the elderly population (over 65 years). Spain 23.6%, the United States 23%, Canada 35.7% and Finland 35.8%. Formulas like MDRD4, CG and CKD-EPI overestimate the glomerular filtrate in the elderly population. However, only the Berlin Initiative Study (BIS1) formula has been studied in the elderly population and has not been shown to be superior to CKD-EPI. In 2011 a new formula to estimate glomerular filtration rate (GFR) was created, called HUGE formula (hematocrit, urea and gender). It will help to assure if the GFR is reduced below 60 ml/min it is due to a physiological process associated with aging or due to true CKD.

OBJECTIVES

Primary Objective:

• To evaluate the sensitivity and specificity of the MDRD4, BIS1 and CG formulas, comparing them with

CKD-EPI as a reference formula for the diagnosis of CKD in elderly patients older than 90 years Secondary objectives:

• To evaluate if the HUGE formula has a prognostic value in patients older than 90 years with GFR less

than 60ml / min / year.

• To analyze the association between comorbidities and glomerular filtration.

METHODS

Prospective longitudinal cohort study. Study the characteristics of patients over 90 years seen in the out patient clinic between 2015 and 2016 in

• Huesca. Also Socio-demographic data, comorbidity, analytical results and drugs were recorded. All collected

data was analyzed with Statistical analysis SPSS 23.

A total of 288 patients with a mean age 94.5 ± 2.4 years, in which 69.8% were female, mean Barthel index of 70, survived the year 81.3%.

RESULTS

Comorbidity

PERCENTAGE CKD* 41% HTA* 78,5% DM 29,2% Dyslipedemia* 45,1% Coronary heart disease 13,9% Cancer 21,9% Hyperuricemia 19,1% Stroke 18,1% Heart Failure 23,6% Nephrolithiasis 2,8% Anemia* 35,2%

RESULTS

DRUGS PERCENTAGE NSAIDS 7% ACE 17,8% ARB * 33% Thiazides 17% Metfomin 8% Loop Diuretic* 39,6%

Drugs NSAIDS: non-steroidal anti-inflammatory drugs. ACE: angiotensin converting enzyme inhibitors. ARB: angiotensin receptor blockers.

3,80% 57,60% 38,50% 35% 53,50% 10,80% 50,30% 42,40% 7,30% 7,30% 79,90% 12,80% 0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00% 70,00% 80,00% 90,00% NORMAL MILD- MODERATE SEVERE % OF PATIENTS DEGREE OF RENAL FAILURE

DEGREE OF KIDNEY FAILURE VS FORMULAS

CG CKD-EPI MDRD4 BIS1

RESULTS

This graph represents the percentages of patients who have each degree of renal failure according to each formula.

RESULTS

GLOMERULAR FILTRATION RATE

GLOMERULAR FILTRATION RATE

eGFR

This graph represents the mean glomerular filtrates according to each formula.

RESULTS

96,20% 49,70% 64,20% 92,70% 0,00% 20,00% 40,00% 60,00% 80,00% 100,00% 120,00% CG MDRD4 CKD-EPI BIS1

% PATIENTS WITH GFR LOWER THAN 60 FÓRMULAS

PATIENTS WITH eGFR LOWER THAN 60ML/MIN

CG MDRD4 CKD-EPI BIS1

This graph represents the percentage of patients with GFR lower than 60ml / min with the different formulas.

RESULTS

GFR THROUGHOUT 1 YEAR GFR

INITIAL 3 MONTHS 6 MONTHS 9 MONTHS 1 YEAR

This graph represents how glomerular filtration behaves throughout the follow-up year, with each formula.

RESULTS

[VALORE] [VALORE]

HUGE

CKD Physiological

This graph represents the result of the HUGE formula, which was performed on patients with less than 60ml / min

• f glomerular filtration per CKD-EPI formula.

CG MDRD4 BI1 CKD-EPI SENSITIVITY INITIAL 100% 77,30% 100% SPECIFICITY INITIAL 10,70% 100% 20,40% SENSITIVITY PER YEAR 100% 82,90% 100% 95,90% SPECIFICITY PER YEAR 8,60% 93,50% 12,90% 74,20%

100% 77,30% 100% 10,70% 100% 20,40% 100% 82,90% 100% 95,90% 8,60% 93,50% 12,90% 74,20%

SENSITIVITY AND SPECIFICITY

RESULTS

This graph represents the sensitivity and specificity, from the start of the study, compared with CKD-EPI and yearly follow-up.

RESULTS

An area under the curve (AUC) was obtained for CG of 89.2% and for MDRD4 and BIS1 of 99.8%. Always compare them with CKD-EPI

RESULTS

Yauden Index

FORMULAS SENSITIVITY SPECIFICITY GFR CG 85,3% 79,4% 37,06ml/min MDRD 4 97,9% 99,9% 68,51ml/min BIS1 98,9% 99,9% 47,62ml/min This index represents the maximum point of sensitivity and specificity to discriminate whether a patient is ill or healthy.

RESULTS

HUGE p ILL HEATHLY MORTALITY ALIVE 10 (10,5%) 85 (89,5%) p= 0,003* DEAD 25 (27,8%) 65 (72,2%) ANEMIA ANEMIA 11 (11,6%) 84 (88,4%) p= 0,000* NOT ANEMIA 55 (61,1%) 35 (38,9%)

HYPERURICEMIA

ILL 115 (49,4%) 105 (45,1%) 13 (5,6%) p= 0,001* HEATHLY 13 (24,1%) 32 (59,3%) 9 (16,7%) GFR p

Since it was not a funded study, it was not possible to compare the different formulas with inulin clearance, which was compared to CKD-EPI, which is recommended by the guidelines and is used at the national level.

LIMITATIONS OF THE STUDY

CONCLUSIONS

• It is confirmed that despite different and new formulas for estimating glomerular filtration, CKD-EPI

continues to be the most sensitive and specific even in older patients.

• The current formulas overestimate or underestimate the diagnosis of CKD, which may be physiological in

the elderly, so it is advisable to use the HUGE formula in a complementary way, which also gives us prognostic value.

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