Characteristics And Risk Factors Associated With Prognosis Among Hospitalized Elderly Patients With Chronic Kidney Disease

Background and Objective:The proportion of elderly people is steadily rising worldwide,with the most rapid growth in low-income and middle-income countries.Chronic kidney disease(CKD)is a common disorder in older people.However,less is known about the epidemiology of CKD among elderly persons and its relationship with adverse consequences.This study aims to carry out a multicenter epidemiological investigation and retrospective cohort study among hospitalized elderly patients with CKD,providing important information for clinical guidelines and healthcare policies in elderly patients with CKD.Methods:For part 1 and part 2,we obtained patients' medical records from a national-wide database including 18 hospitals across China(2009.1.1-2011.12.31).Only data from adult patients(aged 18 years of older)were included.ICD-10-CM coding system was used as the diagnosis of the disease.We analyze the characteristics of elderly patients with CKD in China,including etiology of CKD,pathological types,comorbidity conditions,and in-hospital mortality.Logistic multivariate regression analysis was used to identify independent risk factors for death.For part 3,we enrolled patients diagnosed with CKD in PLA General Hospital from 2012 to 2016,and we followed them for more than one year or to the occurrence of outcomes.The study outcomes were all-cause mortality and ESRD.The outcomes between two groups were analyzed by Kaplan-Meier method.Univariate and multivariate Cox regression model were used to identify the risk factors associated with ESRD and death.Results:1.A total of 380,461 patients were included,of whom 154231 were elderly patients.Among the the elderly 6966 were diagnosed as CKD.The top three causes of CKD among the elderly are diabetic nephropathy,hypertension-related renal impairment and primary glomerular disease,accounting for 24.1%,20.9%,and 11.1%,respectively.2.Among the elderly patients with primary glomerular disease had a pathological diagnosis,membranous nephropathy is the most common type(54.6%),followed by IgA nephropathy(36.1%)and mesangial proliferative glomerulonephritis(13.6%).71.6%of the elderly patients with CKD had more than two comorbidities.The in-hospital mortality rate of the elderly with CKD was 3.3%,which was significantly higher than young patients(1.0%).Logistic regression analysis showed age(OR=1.086,95%CI 1.064-1.108),CKD Stage 5(OR=2.708,95%CI 1.988-3.787),acidosis(OR=4.430,95%CI 2.223-8.827),cardio-cerebrovascular disease(OR=2.301,95%CI 1.701-3.113),infection(OR=1.867,95%CI 1.124-3.102),tumors(OR=3.782,95%CI 2.434-5.876),dementia(OR=8.281,95%CI 1.593-43.037 were independent risk factor for death among elderly patients with CKD.3.A total of 2476 patients were included in the cohort study,among them 220 were older than 65.During follow-up,66 cases(33%)progressed to ESRD and 50 cases(22.7%)died among elderly patients with CKD.Kaplan-Meier analysis revealed an increased incidence of ESRD and all-cause mortality in elderly patients compared with the young.Among the elderly patients with CKD,multivariate Cox regression showed that baseline systolic pressure(HR 1.014,95%CI 1.001-1.027),urea nitrogen(HR 1.098,95%CI 1.043-1.157),eGFR(HR 0.963,95%CI 0.941-0.986),and hemoglobin(HR 0.985,95%CI 0.972-0.998)were factors associated with progress of ESRD.Age(HR 1.105,95%CI 1.045-1.169),cardio-cerebrovascular disease(HR 2.244,95%CI 1.027-4.904),infection(HR 2.448,95%CI l.060-5.654),tumors(HR 3.123,95%CI 1.458-6.689),COPD(HR 2.486,95%CI 1.153-5.358)were risk factors of all-cause death.Conclusions:The CKD etiology of elderly is different from that of non-elderly.Diabetic nephropathy and hypertension-related renal injury are the first two common causes,followed by primay glomerular disease.More than 2/3 of the elderly CKD have comorbid conditions,and the number of comorbidities increased with age.The incidence of ESRD and the rate of all-cause mortality in elderly patients is higher compared with the young.Baseline systolic pressure,urea nitrogen,eGFR,and hemoglobin were factors associated with progress of ESRD.Age,cardio-cerebrovascular disease,infection,tumor,COPD were risk factors of all-cause death...