The following is a summary of “Risk factor for progression to kidney failure with replacement therapy in elderly patients with chronic kidney disease: A retrospective single-centre cohort study,” published in the June 2023 issue of Nephrology by Nagae, et al.

The number of elderly patients with chronic kidney disease (CKD) has been increasing; however, there is a lack of studies investigating their prognosis.

The retrospective cohort study was conducted at a single center and included 301 patients aged ≥75 years with CKD stages G3a to G5. The primary endpoint was kidney failure with replacement therapy (KFRT), and the secondary endpoints were all-cause mortality and the annual decline rates of estimated glomerular filtration rate (eGFR). The incidence of KFRT was estimated using the cumulative incidence method, considering the competing risk of death. In addition, Multivariate Fine-Gray regression model analysis was performed to identify independent risk factors associated with KFRT.

The median age of the patients was 79 years, and the median eGFR at baseline was 24.0 mL/min/1.73 m². Positive urinary protein was observed in 70% of patients. However, during a median follow-up of 24.5 months, 35% of patients developed KFRT, and 9% died. Kidney survival significantly decreased with the progression of the CKD stage at baseline. In patients without proteinuria, the cumulative incidence of KFRT increased among those with CKD stage G5, while in patients with proteinuria, the incidence of KFRT increased starting from CKD stage G3b. The multivariate Fine-Gray regression model revealed that younger age, CKD stage G5, and baseline factors such as proteinuria, hypoalbuminemia, hyperphosphatemia, and hyperuricemia were independent risk factors for KFRT.

Elderly CKD patients with proteinuria require careful monitoring, even at an early stage of CKD, due to the increased risk of developing KFRT.

Source: onlinelibrary.wiley.com/doi/10.1111/nep.14163