Daugirdas JT, Meyer K, Greene T, et al. Evidence suggests that a rapid decline in renal function is associated with an increased risk of cardiovascular and all-cause mortality (9,10). There were 6083 participants who were hypertensive, mostly white, and aged 65–84 years who were enrolled during 1995–1997 and randomized to receive either an ACEI- or thiazide diuretic–based BP lowering regimen. During the in-trial period of our study, over a median of 4 years, we observed an average 0.55 ml/min per 1.73 m2 decline in eGFR annually among the study participants. However, there is inadequate evidence on the relationship between a rapid rate of change in renal function and the risk of fatal events in elderly patients treated for hypertension. During the ANBP2 trial period, 29% of the participants achieved on-treatment target for both systolic BP and diastolic BP <140/90 mmHg. We did not observe any higher risk of mortality with a rapid increase in eGFR as reported in previous studies (11,12,28). (1994) The Italian Longitudinal Study on Aging (ILSA): design and methods. J Bras Nefrol. There is no clear evidence on which BP-lowering drug class has a greater protective effect on the rate of change of renal function or CKD progression (41); however, some studies suggest that ACEI might delay the progression of CKD in low-risk hypertensive patients (15,19). Drug elimination changes in the elderly Decreased renal functions – decreased blood flow to the kidneys – decreased glomerular filtration – decreased tubular secretion – decline in creatinine clearance Table 23.2. All analyses were performed using Stata version 11.2 for Windows (26). Details relating to the ANBP2 clinical trial and the main findings have been previously published (20). No. In the United States, as in many other developed countries, the incidence of treated end stage renal disease (ESRD) increases with advancing age; the highest rates are observed in individuals between the ages of 75 and 79 (Figure 1) (1). To our knowledge, this study is the first to analyze the association of both total and HMW adiponectin levels with eGFRcys decline in an elderly general population without moderate or severe CKD. We observed no differences in baseline eGFRs between those who have or did not have serum creatinine values during follow-up. The most likely reason for a weaker relationship when adjusting for the last eGFR is that those who were observed having rapid decline in eGFR over time might have had a lower level of eGFR at the end, even though previously at baseline many of them had better renal function. With advancing age and in the absence of any disease, there is a significant alteration in kidney structure and a gradual decline in renal function. It has been suggested that the impaired insulin … Lew SW, Bosch JP. Multiple antihypertensive drug use, which tends to be associated with lower BP (37,38), was also associated with a rapid decline in eGFR in these elderly participants. Rate of Change in Renal Function and Mortality in Elderly Treated Hypertensive Patients, DOI: https://doi.org/10.2215/CJN.07370714. Following the Second Australian National Blood Pressure study, participants were followed-up for a further median 6.9 years (post-trial). Second Australian National Blood Pressure Study Group. This is, in part, offset by diminished glucose tolerance, which appears to be due to defective insulin secretion and action with aging. In conclusion, renal function decline with advancing age is well established. Moreover, more studies are needed to elucidate causal pathways. Saudi J Kidney Dis Transpl. Once the kidneys fail, the only recourse available for an elderly person is dialysis or kidney transplantation. In the elderly, the incidence of primary renal diseases declines while the incidence of renal diseases secondary to systemic disease increases. AGN, while essentially a disease of the young, does occur in the older age group. Denic A, Glassock RJ, Rule AD. Contrary to findings in populations with CKD, neither total nor HMW adiponectin had a substantial association with renal function decline in an elderly population with eGFRcys ≥60 mL/min/1.73 m 2. The incidence and prevalence of chronic renal disease (CKD) in elderly patients are continuously increasing worldwide. Brown, G.L.R. Jayaraman R, Ganapathy E, Balakrishnan S, Prashanth S, Akila R. Saudi J Kidney Dis Transpl. The kidneys are part of the urinary system, which also includes the ureters, bladder, and urethra. Kidney disease can develop at any time, but those over the age of 60 are more likely than not to develop kidney disease. 2015 Nov 28;386(10009):2145-91 After adjustment for clustering of participants within family practice, the following predictors were associated with rapid decline in eGFRs compared with those in the stable eGFR group: older age (≥75 years at study entry), living in a rural area, having a wider pulse pressure, having a higher eGFR at baseline, randomized to receive diuretic-based therapy, achieving target BP (<140/90 mmHg), and requiring multiple antihypertensive drugs during the in-trial study period (Table 2). The findings from this study may have implications for clinicians making decisions about the management of hypertension in older patients and taking protective measures to reduce cardiovascular risk. In our study, the elderly patients kept under regular surveillance in the nephrology clinic tended to have more advanced renal impairment and were more likely to have a rapid decline in kidney function. However, the findings from our study should not be taken as a clinical message to avoid achieving a target BP of <140/90 mmHg in older patients because BP control has a number of beneficial effects (39,40), which may outweigh any observed deleterious effect on renal function. Results A rapid decline in eGFR in comparison with those with stable eGFRs during the in-trial period was associated with older age, living in a rural area, wider pulse pressure at baseline, receiving diuretic-based therapy, taking multiple antihypertensive drugs, and having blood pressure <140/90 mmHg during the study. Author information: (1)Division of Nephrology, Hypertension and Endocrinology. Therefore, the serum creatinine concentrations were reduced by 5% using the calibration process that has been used in other epidemiologic studies (24,25). ... Benjamin A Steinberg, Eric D Peterson, Jonathan P Piccini, Decline in renal function and oral anticoagulation dose reduction among patients with atrial fibrillation, Heart, 10.1136/heartjnl-2019-315792, 106, 5, (358-364), (2020). | PubMed PubMedCentral CrossRef Google Scholar. Print. Global Status Report on Noncommunicable Diseases 2010. It is possible that the mechanisms by which ACEI reduce systemic vascular resistance in patients with hypertension may have a renoprotective effect over the long term because with a diminished renal perfusion pressure, the kidney is able to maintain both blood flow and glomerular filtration (42,43). Kidney Problems. AKI in elderly people can often be anticipated and pre-vented. 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