Tuesday, June 18, 2024

Impact of Age on CVD Risk Prediction Using eGFR and Proteinuria

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The relationship between kidney function markers and cardiovascular disease (CVD) risk in the elderly is a growing concern as populations age. A recent study sheds light on how estimated glomerular filtration rate (eGFR) and proteinuria, commonly used indicators of kidney health, influence CVD outcomes in older adults, particularly those aged 85 and above. As eGFR declines and proteinuria increases with age, understanding their independent and combined effects on CVD risk becomes crucial for better clinical management and preventive strategies.

Study Overview

Researchers analyzed the distribution of eGFR and proteinuria in a retrospective cohort of 1,829,020 individuals in Japan, using administrative claims and health checkup data spanning from April 2014 to November 2022. After excluding individuals with pre-existing CVD, 1,040,101 participants aged 40 and above were assessed to explore the association between eGFR, proteinuria, and CVD incidence, with a particular focus on aging’s impact.

The study found that the prevalence of impaired kidney function (eGFR <60 mL/min/1.73 m2) increased significantly with age. Similarly, the proportion of individuals with positive proteinuria also rose with advancing age. Both eGFR and urine protein were identified as independent risk factors for CVD. Notably, the risk associated with lower eGFR was more pronounced in younger age groups, whereas proteinuria remained a significant risk factor across all ages.

Key Findings

The hazard ratios for CVD were significantly elevated in individuals with eGFR <45 mL/min/1.73 m2 for ages 40-64, 65-74, and 75-84. In contrast, for those aged 85 and above, the risk became significant at eGFR <30 mL/min/1.73 m2. Proteinuria consistently showed a strong association with increased CVD risk, irrespective of age or sex.

These findings underscore the importance of monitoring both eGFR and proteinuria in predicting CVD risk, especially in older adults. While the impact of declining eGFR on CVD risk diminishes with age, the presence of proteinuria remains a potent indicator of heightened risk across all age groups.

Practical Inferences for Healthcare Providers

– Monitoring eGFR and proteinuria can help identify high-risk individuals for CVD, even in advanced age.
– Declining eGFR (2) significantly raises CVD risk in younger seniors (40-84 years).
– For those aged ≥85, a lower eGFR threshold (2) becomes critical.
– Proteinuria remains a robust risk factor for CVD independent of age, necessitating consistent monitoring in elderly patients.

In conclusion, while eGFR’s role in predicting CVD risk diminishes with age, proteinuria maintains its significance. This study highlights the necessity for tailored approaches in managing CVD risk among older adults, considering the differential impact of kidney function markers.

Original Article: Nephrol Dial Transplant. 2024 Jun 10:gfae124. doi: 10.1093/ndt/gfae124. Online ahead of print.

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