CKD and mortality risk in older people: a community-based population study in the United Kingdom

Roderick, Paul J., Atkins, Richard J., Smeeth, Liam, Mylne, Adrian, Nitsch, Dorothea D.M., Hubbard, Richard B., Bulpitt, Christopher J. and Fletcher, Astrid E. (2009) CKD and mortality risk in older people: a community-based population study in the United Kingdom. American Journal of Kidney Diseases, 53, (6), 950-960. (doi:10.1053/j.ajkd.2008.12.036).


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Background: the prevalence of chronic kidney disease (CKD) increases with age; however, the
prognostic significance in older people is uncertain. This study aims to determine the association of CKD
with all-cause and cardiovascular mortality in community-dwelling older people 75 years and older.
Study Design: Cohort study of people 75 years and older recruited in 1994 to 1999 to 1 arm of a trial
of multidimensional health assessment with mortality follow-up.
Setting & Participants: 53 general practices in Great Britain. 15,336 (73%) of those eligible
participated. 13,177 (86%) had serum creatinine measured at baseline.

Main Factor: estimated glomerular filtration rate (eGFR).
Outcomes: All-cause and cardiovascular mortality.
Measurements: eGFR derived from serum creatinine level using the 4-variable Modification of Diet in
Renal Disease (MDRD) Study equation in milliliters per minute per 1.73 m2; dipstick proteinuria.
Mortality by linkage to national death registration and death certification.

Results: after a median follow-up of 7.3 years (interquartile range, 5.0), 7,633 (58%) had died, 42% of
cardiovascular causes. In the first 2 years of follow-up, adjusted hazard ratios for all-cause mortality in
eGFR bands of 45 to 59, 30 to 44, and less than 30 compared with eGFR greater than 60 mL/min/1.73
m2 were 1.13 (95% confidence interval, 0.93 to 1.37), 1.69 (95% confidence interval, 1.26 to 2.28), and
3.87 (95% confidence interval, 2.78 to 5.38) in men and 1.14 (95% confidence interval, 0.93 to 1.40),
1.33 (95% confidence interval, 1.06 to 1.68), and 2.44 (95% confidence interval, 1.68 to 3.56) in women,
respectively. Hazard ratios were greater for cardiovascular mortality and lower after 2 years. Dipstick
proteinuria was independently associated with all-cause, but not cardiovascular, mortality risk in both

Limitations: single serum creatinine measurement, no calibration of serum creatinine, MDRD Study
equation not validated in older people.
Conclusion: As kidney function decreases, there is a graded and independent increase in all-cause
and cardiovascular mortality risk in older people 75 years and older, especially in men and those with
eGFR less than 45 mL/min/1.73 m2. Dipstick proteinuria did not add to cardiovascular mortality risk in
this elderly population. In older people, identification and management of CKD should prioritize the
smaller numbers with more severe CKD.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1053/j.ajkd.2008.12.036
ISSNs: 0272-6386 (print)
1523-6838 (electronic)
Related URLs:
Keywords: chronic kidney disease, mortality, survival, older people
Subjects: R Medicine > R Medicine (General)
Divisions : University Structure - Pre August 2011 > School of Medicine > Community Clinical Sciences
Faculty of Medicine > Primary Care and Population Sciences
ePrint ID: 146771
Accepted Date and Publication Date:
June 2009Published
Date Deposited: 22 Apr 2010 13:51
Last Modified: 31 Mar 2016 13:21

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