Elke S Schaeffner1, Natalie Ebert2, Martin K Kuhlmann3, Peter Martus4, Nina Mielke2, Alice Schneider5, Markus van der Giet6, Dörte Huscher5. 1. Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany elke.schaeffner@charite.de. 2. Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany. 3. Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany. 4. Institute of Clinical Epidemiology and Applied Biostatistics, Friedrich Karls-University, Tübingen, Germany. 5. Institute of Biometry and Clinical Epidemiology, and Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany. 6. Division of Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Abstract
BACKGROUND AND OBJECTIVES: In older adults, data on the age-related course of GFR are scarce, which might lead to misjudgment of the clinical relevance of reduced GFR in old age. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: To describe the course of eGFR in older adults and derive reference values in population-based individuals, we used the longitudinal design of the Berlin Initiative Study (BIS) with a repeated estimation of GFR over a median of 6.1 years of follow-up. In 2069 community-dwelling older individuals (mean inclusion age 80 years, range 70-99), GFR was estimated biennially with the BIS-2 equation, including standardized creatinine and cystatin C levels, sex, and age. We described the crude and adjusted course using a mixed-effects model and analyzed the influence of death on the GFR course applying joint models. GFR slopes were compared using GFR equations on the basis of creatinine and/or cystatin C. RESULTS: We observed a decreasing, thus nonlinear, eGFR decline with increasing age in a population of old adults. The estimated 1-year slope for ages 75 and 90 diminished for men from -1.67 to -0.99 and for women from -1.52 to -0.97. The modeled mean eGFR for men aged ≥79 and women ≥78 was below 60 ml/min per 1.73 m2. Multivariable adjustment attenuated slopes only minimally. Taking death into account by applying joint models did not alter the nonlinear eGFR decline. Using eGFR equations on the basis of creatinine only showed linear slope patterns in contrast to nonlinear patterns for equations including cystatin C. CONCLUSIONS: The eGFR decline depended on sex and age and changed only marginally after multivariable adjustment but decelerated with increasing age. Equations including cystatin C demonstrated a nonlinear slope challenging the previously assumed linearity of the decline of eGFR in old age.
BACKGROUND AND OBJECTIVES: In older adults, data on the age-related course of GFR are scarce, which might lead to misjudgment of the clinical relevance of reduced GFR in old age. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: To describe the course of eGFR in older adults and derive reference values in population-based individuals, we used the longitudinal design of the Berlin Initiative Study (BIS) with a repeated estimation of GFR over a median of 6.1 years of follow-up. In 2069 community-dwelling older individuals (mean inclusion age 80 years, range 70-99), GFR was estimated biennially with the BIS-2 equation, including standardized creatinine and cystatin C levels, sex, and age. We described the crude and adjusted course using a mixed-effects model and analyzed the influence of death on the GFR course applying joint models. GFR slopes were compared using GFR equations on the basis of creatinine and/or cystatin C. RESULTS: We observed a decreasing, thus nonlinear, eGFR decline with increasing age in a population of old adults. The estimated 1-year slope for ages 75 and 90 diminished for men from -1.67 to -0.99 and for women from -1.52 to -0.97. The modeled mean eGFR for men aged ≥79 and women ≥78 was below 60 ml/min per 1.73 m2. Multivariable adjustment attenuated slopes only minimally. Taking death into account by applying joint models did not alter the nonlinear eGFR decline. Using eGFR equations on the basis of creatinine only showed linear slope patterns in contrast to nonlinear patterns for equations including cystatin C. CONCLUSIONS: The eGFR decline depended on sex and age and changed only marginally after multivariable adjustment but decelerated with increasing age. Equations including cystatin C demonstrated a nonlinear slope challenging the previously assumed linearity of the decline of eGFR in old age.
Authors: Elke S Schaeffner; Markus van der Giet; Jens Gaedeke; Markus Tölle; Natalie Ebert; Martin K Kuhlmann; Peter Martus Journal: Eur J Epidemiol Date: 2010-01-22 Impact factor: 8.082
Authors: Bjørn O Eriksen; Runolfur Palsson; Natalie Ebert; Toralf Melsom; Markus van der Giet; Vilmundur Gudnason; Olafur S Indridason; Lesley A Inker; Trond G Jenssen; Andrew S Levey; Marit D Solbu; Hocine Tighiouart; Elke Schaeffner Journal: J Am Soc Nephrol Date: 2020-06-04 Impact factor: 10.121
Authors: Lesley A Inker; Christopher H Schmid; Hocine Tighiouart; John H Eckfeldt; Harold I Feldman; Tom Greene; John W Kusek; Jane Manzi; Frederick Van Lente; Yaping Lucy Zhang; Josef Coresh; Andrew S Levey Journal: N Engl J Med Date: 2012-07-05 Impact factor: 91.245
Authors: Lawrence J Appel; Jackson T Wright; Tom Greene; John W Kusek; Julia B Lewis; Xuelei Wang; Michael S Lipkowitz; Keith C Norris; George L Bakris; Mahboob Rahman; Gabriel Contreras; Stephen G Rostand; Joel D Kopple; Francis B Gabbai; Gerald I Schulman; Jennifer J Gassman; Jeanne Charleston; Lawrence Y Agodoa Journal: Arch Intern Med Date: 2008-04-28