Tasa de filtrado glomerular estimada, eventos cardiovasculares y mortalidad por grupos de edad en individuos de 60 o más años del sur de Europa / Estimated glomerular filtration rate, cardiovascular events and mortality across age groups among individuals older than 60 years in Southern Europe

Introducción y objetivos: Los individuos con tasa de filtrado glomerular estimada (TFGe) disminuida tienen mayor riesgo de muerte por todas las causas (MT) y cardiovascular; se debate si los sujetos mayores con TFGe entre 45 y 59 ml/min/1,73 m2 también tienen un riesgo aumentado. Se evaluó la asociación entre la TFGe y la MT y los eventos cardiovasculares (ECV) en individuos de edad 60-74 y ≥ 75 años en un área de baja incidencia de enfermedad coronaria. Métodos: Se realizó un estudio retrospectivo de cohortes utilizando registros electrónicos de atención primaria y hospital. Se incluyó a 130.233 individuos de 60 o más años con una determinación de creatinina entre el 1 de enero de 2010 y el 31 de diciembre de 2011 y una TFGe según la fórmula de la Chronic Kidney Disease Epidemiology Collaboration. Las asociaciones independientes entre la TFGe y la MT y el ingreso por ECV se evaluaron mediante modelos de regresión de Cox y Fine-Gray respectivamente. Resultados: Media de edad, 70 años; el 56,1% eran mujeres. El 13,5% tenía una TFGe < 60 (el 69,7%, TFGe 45-59). Durante una mediana de seguimiento de 38,2 meses, 6.474 participantes fallecieron y 3.746 presentaron ECV. Tanto para la MT como para los ECV, las HR ajustadas de los participantes de 75 o más años fueron significativas con TFGe < 60. Con TFGe 45-59, para MT fueron HR = 1,61; IC95%, 1,37-1,89 y HR = 1,19; IC95%, 1,10-1,28 en los grupos de edad de 60-74 y ≥ 75 años respectivamente, y para ECV, HR = 1,28; IC95%, 1,08-1,51 y HR = 1,12; IC95%, 0,99-1,26. Conclusiones: En un área de baja incidencia de enfermedad coronaria, el riesgo de muerte y ECV fue de mayor a menor TFGe. A edades ≥ 75 años, la categoría de TFGe 45-59, en el límite significativo de ECV, incluyó a muchos individuos sin riesgo adicional significativo

Introduction and objectives: Individuals with a decreased estimated glomerular filtration rate (eGFR) are at increased risk of all-cause (ACM) and cardiovascular mortality; there is ongoing debate about whether older individuals with eGFR 45 to 59 mL/min/1.73 m2 are also at increased risk. We evaluated the association between eGFR and ACM and cardiovascular events (CVE) in people aged 60 to 74 and ≥ 75 years in a population with a low coronary disease incidence. Methods: We conducted a retrospective cohort study by using primary care and hospital electronic records. We included 130 233 individuals aged ≥ 60 years with creatinine measurement between January 1, 2010 and December 31, 2011; eGFR was estimated by using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. The independent association between eGFR and the risk of ACM and hospital admission due to CVE were determined with Cox and Fine-Gray regressions, respectively. Results: The median was age 70 years, and 56.1% were women; 13.5% had eGFR < 60 (69.7% eGFR 45-59). During a median follow-up of 38.2 months, 6474 participants died and 3746 had a CVE. For ACM and CVE, the HR in older individuals became significant at eGFR < 60. Fully adjusted HR for ACM in the eGFR 45 to 59 category were 1.61; 95%CI, 1.37-1.89 and 1.19; 95%CI, 1.10-1.28 in 60- to 74-year-olds and ≥ 75-year-olds, respectively; for CVE HR were 1.28; 95%CI, 1.08-1.51 and 1.12; 95%CI, 0.99-1.26. Conclusions: In a region with low coronary disease incidence, the risk of death and CVE increased with decreasing eGFR. In ≥ 75-year-olds, the eGFR 45 to 59 category, which had borderline risk for CVE, included many individuals without significant additional risk

Estimated Glomerular Filtration Rate, Cardiovascular Events and Mortality Across Age Groups Among Individuals Older Than 60 Years in Southern Europe.

INTRODUCTION AND OBJECTIVES: Individuals with a decreased estimated glomerular filtration rate (eGFR) are at increased risk of all-cause (ACM) and cardiovascular mortality; there is ongoing debate about whether older individuals with eGFR 45 to 59mL/min/1.73 m2 are also at increased risk. We evaluated the association between eGFR and ACM and cardiovascular events (CVE) in people aged 60 to 74 and ≥ 75 years in a population with a low coronary disease incidence. METHODS: We conducted a retrospective cohort study by using primary care and hospital electronic records. We included 130 233 individuals aged ≥ 60 years with creatinine measurement between January 1, 2010 and December 31, 2011; eGFR was estimated by using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. The independent association between eGFR and the risk of ACM and hospital admission due to CVE were determined with Cox and Fine-Gray regressions, respectively. RESULTS: The median was age 70 years, and 56.1% were women; 13.5% had eGFR < 60 (69.7% eGFR 45-59). During a median follow-up of 38.2 months, 6474 participants died and 3746 had a CVE. For ACM and CVE, the HR in older individuals became significant at eGFR < 60. Fully adjusted HR for ACM in the eGFR 45 to 59 category were 1.61; 95%CI, 1.37-1.89 and 1.19; 95%CI, 1.10-1.28 in 60- to 74-year-olds and ≥ 75-year-olds, respectively; for CVE HR were 1.28; 95%CI, 1.08-1.51 and 1.12; 95%CI, 0.99-1.26. CONCLUSIONS: In a region with low coronary disease incidence, the risk of death and CVE increased with decreasing eGFR. In ≥ 75-year-olds, the eGFR 45 to 59 category, which had borderline risk for CVE, included many individuals without significant additional risk.

Enfermedad renal crónica en Atención Primaria: prevalencia y factores de riesgo asociados / Chronic kidney disease in Primary Health Care: Prevalence and associated risk factors

OBJETIVO: Conocer la prevalencia y los estadios de la enfermedad renal crónica según la estimación del filtrado glomerular (eFG), y los factores de riesgo asociados en individuos ≥ 60 años. DISEÑO: Estudio observacional transversal. Emplazamiento: Atención Primaria. PARTICIPANTES: Sujetos ≥ 60 años de 40 centros de Atención Primaria con determinación de creatinina sérica entre 1 enero-31 diciembre de 2010. Criterios de exclusión: trasplante renal, atención domiciliaria. MEDICIONES PRINCIPALES: Variables sociodemográficas, antropométricas, factores de riesgo y enfermedad cardiovascular según registro en historia clínica electrónica, concentración de creatinina sérica según método Jaffé cinético compensado estandarizado y eFG según MDRD-4 IDMS y CKD-EPI. RESULTADOS: Fueron analizados 97.665 individuos (57,3% mujeres, mediana de edad 70,0 [Q1: 65,0; Q3: 77,0]). Prevalencia de eFG-MDRD < 60 = 15,1% (16,6% en mujeres, 13,2% en hombres; p < 0,001) con aumento progresivo con la edad. El análisis multivariante detectó una asociación positiva entre eFG-MDRD < 60 y edad (OR = 1,74; IC 95% 1,70-1,77), HTA (OR = 2,18; IC 95% 2,08-2,30), insuficiencia cardiaca (OR = 2,03; IC 95% 1,83-2,25), fibrilación auricular (OR = 1,57; IC 95% 1,41-1,76), cardiopatía isquémica (OR = 1,40; IC 95% 1,30-1,50), arteriopatía periférica (OR = 1,31; IC 95% 1,09-1,57), dislipidemia (OR = 1,28; IC 95% 1,23-1,33), DM (OR = 1,26; IC 95% 1,17-1,34) y AVC (OR = 1,17; IC 95% 1,09-1,25). El modelo con eFG-CKD-EPI mostró un aumento de la OR con la edad y sexo masculino, que cobró significación como factor de riesgo. CONCLUSIONES: La enfermedad renal crónica presenta una importante prevalencia en pacientes ≥ 60 años atendidos en Atención Primaria, mayor en mujeres que en hombres, y aumentando con la edad. La HTA, más que la DM, fue el principal factor de riesgo cardiovascular asociado

OBJECTIVE: To determine the prevalence of chronic kidney disease and associated risk factors in subjects over 60 years of age, as well as its staging by determining the glomerular filtration rate (GFR). DESIGN: Cross-sectional observational study. SETTING: Primary Health Care. PARTICIPANTS: Patients ≥ 60 years of age who were seen in 40 Primary Health Care centres with serum creatinine measured in a central laboratory between January 1 and December 31, 2010. Exclusion criteria: kidney transplant, home care. Main measures: Social-demographic and anthropometric data, cardiovascular risk factors, and diseases established according to electronic clinical records. Serum creatinine was measured using standardised Jaffe kinetic method, and GFR estimated with MDRD-4-IDMS and CKD-EPI. RESULTS: A total of 97,665 subjects (57.3% women, median age 70.0 years [Q1: 65.0, Q3: 77.0]). GFR-MDRD prevalence < 60 = 15.1% (16.6% in women, 13.2% in men; P < .001) and increased with age. Multivariate analysis showed a positive association between GFR-MDRD < 60 and age (OR = 1.74; 95% CI 1.70 to 1.77), hypertension (OR = 2.18; 95% CI 2.08 to 2.30), heart failure (OR = 2.03; 95% CI 1.83 to 2.25), atrial fibrillation (OR = 1.57; 95% CI 1.41 to 1.76), ischaemic heart disease (OR = 1.40; 95% CI 1.30 to 1.50), peripheral arterial disease (OR = 1.31; 95% CI 1.09 to 1.57), dyslipidaemia (OR = 1.28; 95% CI 1.23 to 1.33), diabetes (OR = 1.26; 95% CI 1.17 to 1.34), and stroke (OR = 1.17; 95% CI 1.09 to 1.25). The GFR-CKD-EPI model showed an increase in OR with age and male sex, that became significant as a chronic kidney disease risk factor. CONCLUSIONS: Chronic kidney disease has considerable prevalence in subjects ≥ 60 years seen in Primary Health Care, more in women, and increasing with age. Hypertension, more than diabetes, was the main associated cardiovascular risk factor

[Chronic kidney disease in Primary Health Care: prevalence and associated risk factors]. / Enfermedad renal crónica en Atención Primaria: prevalencia y factores de riesgo asociados.

OBJECTIVE: To determine the prevalence of chronic kidney disease and associated risk factors in subjects over 60 years of age, as well as its staging by determining the glomerular filtration rate (GFR). DESIGN: Cross-sectional observational study. SETTING: Primary Health Care. PARTICIPANTS: Patients≥60 years of age who were seen in 40 Primary Health Care centres with serum creatinine measured in a central laboratory between January 1 and December 31, 2010. EXCLUSION CRITERIA: kidney transplant, home care. MAIN MEASURES: Social-demographic and anthropometric data, cardiovascular risk factors, and diseases established according to electronic clinical records. Serum creatinine was measured using standardised Jaffe kinetic method, and GFR estimated with MDRD-4-IDMS and CKD-EPI. RESULTS: A total of 97,665 subjects (57.3% women, median age 70.0 years [Q1: 65.0, Q3: 77.0]). GFR-MDRD prevalence<60=15.1% (16.6% in women, 13.2% in men; P<.001) and increased with age. Multivariate analysis showed a positive association between GFR-MDRD<60 and age (OR=1.74; 95% CI 1.70 to 1.77), hypertension (OR=2.18; 95% CI 2.08 to 2.30), heart failure (OR=2.03; 95% CI 1.83 to 2.25), atrial fibrillation (OR=1.57; 95% CI 1.41 to 1.76), ischaemic heart disease (OR=1.40; 95% CI 1.30 to 1.50), peripheral arterial disease (OR=1.31; 95% CI 1.09 to 1.57), dyslipidaemia (OR=1.28; 95% CI 1.23 to 1.33), diabetes (OR=1.26; 95% CI 1.17 to 1.34), and stroke (OR=1.17; 95% CI 1.09 to 1.25). The GFR-CKD-EPI model showed an increase in OR with age and male sex, that became significant as a chronic kidney disease risk factor. CONCLUSIONS: Chronic kidney disease has considerable prevalence in subjects≥60 years seen in Primary Health Care, more in women, and increasing with age. Hypertension, more than diabetes, was the main associated cardiovascular risk factor.