Seguimiento de la función renal y factores que influyen en su evolución en una cohorte de personas de 65 a 74 años de edad

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Abstract

RESUMEN Objetivos: Estudiar la evolución de la función renal en el anciano joven en un periodo de cuatro años. Diseño: Observacional, descriptivo, longitudinal Emplazamiento: Centro de Salud urbano. Participantes: Población de entre 65 y 74 años asignado a un Centro de Salud. Mediciones Principales: Creatinina y filtrado glomerular según CKD-EPI. Ademas, variables sociodemográficas, factores de riesgo cardiovascular y número de enfermedades crónicas y fármacos. Resultados: La muestra inicial fueron 557 pacientes con un 13,1 % de pérdidas al final del estudio. Al inicio, edad media de 68,9 años, con un 55,1 % de mujeres. La creatinina media evolucionó desde 0,87 mg/dl (IC95% 0,83-0,91) a 0,94 (IC95% 0,87-0,99) (p<0,05). El filtrado glomerular medio desde 79,1 ml/min (IC 95% 77,9-80,4) a 74,65 (IC95% 73,3-76,0) (p<0,001), con una reducción media de 4,3 ml/min (IC 95% 3,4-5,2). En el corte inicial 10,2 % (IC95% 7,7- 12,7) presentaban IRC, pasando dicha cifra al 15,3 % (IC95% 12,1-18,5) al final, encuadrándose todo el aumento en el estadio 3. En el análisis bivariante se encontró asociación entre una mayor disminución de filtrado y la presencia de HTA (p<0,05), número de patologías (p<0,01) y el sexo femenino (p<0,05). Sin embargo, en el análisis multivariante sólo el sexo femenino se mantuvo con una asociación significativa (p<0,05) y la HTA casi significativa (p<0,1), pero con diferencias clínicamente irrelevantes. Conclusiones: En ancianos jóvenes, la función renal parece presentar una muy lenta reducción a lo largo del tiempo, ligeramente superior en mujeres. Podría plantearse el espaciamento de las determinaciones de dicha función renal en la población general de este grupo de edad.

Translated abstract

ABSTRACT Objectives: To study the evolution of renal function in younger elderly persons over a period of four years. Design: Observational, descriptive, longitudinal study. Setting: Urban health centre Participants: Population between 65 and 74 years of age assigned to a health centre Main measures: Creatinine and glomerular filtration rate according to CKD-EPI. Also sociodemographic variables, cardiovascular risk factors, and number of chronic diseases and drugs Results: The initial sample included 557 patients, with 12.9 % loss at the end of the study. At the start, the average age was 68.9 years, with 55.1 % women. The mean creatinine evolved from 0.87 mg/dl (95% CI 0.83-0.91) to 0.94 (95%CI 0.87-0.99) (p<0.05). The mean glomerular filtration rate evolved from 79.1 ml/min (95% CI 77.9-80.4) to 74.65 (95% CI 73.3-76.0) (p<0.001), with an average decrease of 4.3 ml/min (95% CI 3.4-5.2). Initially, 10.2% of patients (95% CI 7.7-12.7) presented chronic kidney failure, which increased to 15.3 % (95% CI 12.1-18.5) at the end, being all the increase within stage 3. The bivariate analysis showed association between greater decline of filtration rate and presence of high blood pressure (p<0.05), number of diseases (p<0.01) and female sex (p<0.05). However, in the multivariate analysis only female sex kept a significant association (p<0.05), and high blood pressure had a nearly significant association (p<0.1), but with clinically irrelevant differences. Conclusions: Among younger elderly patients, the renal function seems to present a very slow decline over time, which is slightly greater in women. Spacing of renal function determinations could be considered in general population of this age group .

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Most cited references 25

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A new equation to estimate glomerular filtration rate.

Andrew Levey, Lesley Stevens, Christopher H Schmid … (2009)

Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. National Institute of Diabetes and Digestive and Kidney Diseases.