KIDNEY DISEASE

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Slide 1 : KIDNEY DISEASE Aging - metabolic syndrome - kidney disease Students’ state of the art lectures Wim Janssens, MD Gent, Belgium
Slide 2 : Renal function in the elderly age-dependent fall in glomerular filtration rate (GFR) is not inevitable about 30% of elderly show no decrease in creatinine clearance (Lindeman RD et al, J Am Geriatr Soc 1985; 33: 278-285) chronic kidney disease (CKD) = either kidney damage or GFR < 60 ml/min/1.73m² for at least 3 months kidney damage = pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests and/or imaging studies
Slide 3 : 5 different stages of CKD (National Kidney Foundation Inc, Am J Kidney Dis 2002; 39: S46-S75)
Slide 4 : Prevalence of decrease in GFR and moderate to severe kidney disease in the Belgian elderly population (http://www.nbvn.be; http://www.soc.nephrologie.org; National Kidney Foundation Inc, Am J Kidney Dis 2002; 39: S46-S75)
Slide 5 : Renal function parameters in the oldest-old (Van Den Noortgate et al, International Urology and Nephrology 2001; 32: 531-537) 220 patients, 80 years or older; acute geriatric ward in a tertiairy hospital mean creatinine clearance 38.11 ml/min (+/- 12.04 ml/min); no significant change at discharge 26.4% had renal failure (creatinine clearance < 30 ml/min) (Cockroft-Gault) serumcreatinine not useful as marker of renal failure in the very old (low creatinine production as muscle mass decreases with aging) Cockroft-Gault: overestimation of creatinine clearance at low levels underestimation of creatinine clearance at normal GFR
Slide 6 : Renal function and the metabolic syndrome in the oldest-old (Van Den Noortgate et al, International Urology and Nephrology 2001; 32: 531-537) only a significant correlation between failure to thrive and renal failure (p < 0.0001) no significant correlation between renal failure and arterial hypertension, peripheral arterial disease, heart failure, dementia and diabetes: to small study population? in other studies with patients 65-80 years old (Lindeman RD et al, Kidney Int 1984; 26: 861-868; Fliser D et al, Kidney Int 1997; 51: 1196-1204; Acone D, Kidney Int 1996; 49: 75-77): significant correlation between renal failure and arterial hypertension, vascular disease, diabetes, heart failure
Slide 7 : The metabolic syndrome: definition definition of the metabolic syndrome (ATP III: Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol): at least 3 of the following abnormalities: waist circumference greater than 102 cm (men) or 88 cm (women) serum triglycerides level at least 150 mg/dl (1.69 mmol/l) high-density lipoprotein cholesterol level of less than 40 mg/dl (1.04 mmol/l) (men) or 50 mg/dl (1.29 mmol/l) (women) blood pressure at least 130/85 mmHg serum glucose level at least 110 mg/dl (6.1 mmol/l)
Slide 8 : Prevalence of the metabolic syndrome (Ford ES et al, JAMA 2002; 287: 356-359) objective: to estimate the prevalence of the metabolic syndrome in the US (ATP III) 8814 subjects aged 20 years or older prevalence: 20 - 29 years: 6.7% 60 - 69 years: 43.5% 70 years or older: 42.0%
Slide 9 : Microalbuminuria and the metabolic syndrome (Li Q et al, Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25: 65-68) objective: to study the relationship between the prevalence of microalbuminuria and components of metabolic syndrome in Shangai 3532 subjects aged over 20 years prevalence of microalbuminuria increased with aging (p < 0.001) prevalence of microalbuminuria was independently associated with hypertension and hyperglycemia
Slide 10 : Microalbuminuria and the metabolic syndrome (Palaniappan L et al, AJH 2003; 16: 952-958) objective: to study the association between microalbuminuria and the metabolic syndrome 5659 subjects aged 20 to 80 years microalbuminuria: urinary albumin/creatinine ratio of 30 to 300 mg/g metabolic syndrome in 7.8% of women and 5.0% of men significant association between the metabolic syndrome and microalbuminuria in both genders (p < 0.0001) strongest association between microalbuminuria and hypertension maybe useful to consider microalbuminuria as a component of the metabolic syndrome
Slide 11 : The metabolic syndrome and other age-related diseases (Morley JE, J Gerontol A Biol Sci Med Sci 2004; 59: M139-M142) 15 - 20% of persons aged 70 years or older have the metabolic syndrome in male patients possibly due to an age-related decline in testosteron level dementia and depression should be considered, in some cases, to be due to the metabolic syndrome, because of hyperglycemia and/or vascular dementia
Slide 12 : Take home messages the metabolic syndrome is an emerging problem in the old and the oldest-old (?) the prevalence of the metabolic syndrome increases with age the prevalence of microalbuminuria is related to the metabolic syndrome, more precisely to hypertension and hyperglycemia rigorous treatment of the metabolic syndrome when it first emerges in middle age represents not only a key to life prolongation, but also to extended number of quality-adjusted life years that a person will experience
Slide 13 : References Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985; 33: 278-285; National Kidney Foundation Inc: K/DOQI. Clinical practice guidelines for chronic kidney disease. Part 4. Definition and classification of stages of chronic kidney disease. Am J Kidney Dis 2002; 39: S46-S75; http://www.nbvn.be http://www.soc-nephrologie.org Van Den Noortgate NJ, Janssens WH, Afschrift MB, Lameire NH. Renal function in the oldest-old on an acute geriatric ward. International Urology and Nephrology 2001; 32: 531-537; Lindeman RD, Tobin J, Shock NW. Association between blood pressure and the rate of decline in renal function with age. Kidney Int 1984; 26: 861-868;
Slide 14 : Fliser D, Franek E, Joest M, Block S, Mutschler E, Ritz E. Renal function in the elderly: Impact of hypertension and cardiac function. Kidney Int 1997; 51: 1196-1204; Acone D, Cante D, Cillo F, Giordano G, Giordano C. Blood pressure and progression of renal failure in the elderly. Kidney Int 1996; 49: 75-77; Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults. JAMA 2002; 287: 356-359; Li Q, Jia WP, Lu JQ, Chen L, Wu YM, Jiang SY, Xiang KS. Relationship between the prevalence of microalbuminuria and components of metabolic syndrome in Shangai. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25: 65-68; Palaniappan L, Carnethon M, Fortmann SP. Association between microalbuminuria and the metabolic syndrome: NHANES III. AJH 2003; 16: 952-958; Morley JE. The metabolic syndrome and aging. J Gerontol A Biol Sci Med Sci 2004; 59: M139-M142

 


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