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. 2015 Aug;66(2):240-8.
doi: 10.1053/j.ajkd.2015.03.030. Epub 2015 May 16.

Midlife Blood Pressure and Late-Life GFR and Albuminuria: An Elderly General Population Cohort

Lesley A Inker  1 , Aghogho Okparavero  2 , Hocine Tighiouart  3 , Thor Aspelund  4 , Margret B Andresdottir  5 , Gudny Eiriksdottir  6 , Tamara Harris  7 , Lenore Launer  7 , Hjalmfridur Nikulasdottir  6 , Johanna Eyrun Sverrisdottir  6 , Hrefna Gudmundsdottir  5 , Farzad Noubary  3 , Gary Mitchell  8 , Runolfur Palsson  9 , Olafur S Indridason  5 , Vilmundur Gudnason  4 , Andrew S Levey  2
Affiliations

Midlife Blood Pressure and Late-Life GFR and Albuminuria: An Elderly General Population Cohort

Lesley A Inker et al. Am J Kidney Dis. 2015 Aug.

Abstract

Background: Chronic kidney disease (CKD) is common in the elderly, but the cause is often not identifiable. Some posit that age-related reductions in glomerular filtration rate (GFR) and increases in albuminuria are normal, whereas others suggest that they are a consequence of vascular disease.

Study design: Cross-sectional analysis of a substudy of a prospective cohort.

Setting & participants: AGES (Age, Gene/Environment Susceptibility)-Reykjavik Study.

Predictor: Exposure to higher blood pressure in midlife.

Outcomes & measurements: Measured GFR using plasma clearance of iohexol and urine albumin-creatinine ratio.

Results: GFR was measured in 805 participants with mean age in midlife and late life of 51.0±5.8 and 80.8±4.0 (SD) years, respectively. Mean measured GFR was 62.4±16.5 mL/min/1.73 m(2) and median albuminuria was 8.0 (IQR, 5.4-16.5) mg/g. Higher midlife systolic and diastolic blood pressures were associated with lower later-life GFRs. Associations persisted after adjustment. Higher midlife systolic and diastolic blood pressures were also associated with higher albumin-creatinine ratios, and associations remained significant even after adjustment.

Limitations: This is a study of survivors, and people who agreed to participate in this study were healthier than those who refused. Blood pressure may encompass effects of the other risk factors. Results may not be generalizable to populations of other races. We were not able to adjust for measured GFR or albuminuria at the midlife visit.

Conclusions: Factors other than advanced age may account for the high prevalence of CKD in the elderly. Midlife factors are potential contributing factors to late-life kidney disease. Further studies are needed to identify and treat midlife modifiable factors to prevent the development of CKD.

Keywords: Chronic kidney disease (CKD); aging; albumin-creatinine ratio (ACR); albuminuria; blood pressure; elderly; hypertension; iohexol clearance; measured glomerular filtration rate (mGFR); mid-life; modifiable risk factor; renal function.

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Figures

Figure 1
Figure 1. Association of age with measured GFR (top panel) and albuminuria (bottom panel)
Curves are restricted cubic splines with four knots at the default percentiles locations (5%, 35%, 65% and 95%) from the rms package of the R software. These translate to age of 76, 79, 82 and 88 years for men and 75, 78, 82 and 89 years for women. GFR, glomerular filtration rate (in ml/min/1.73m2). ACR, urinary albumin-creatinine ratio (in mg/g).
Figure 1
Figure 1. Association of age with measured GFR (top panel) and albuminuria (bottom panel)
Curves are restricted cubic splines with four knots at the default percentiles locations (5%, 35%, 65% and 95%) from the rms package of the R software. These translate to age of 76, 79, 82 and 88 years for men and 75, 78, 82 and 89 years for women. GFR, glomerular filtration rate (in ml/min/1.73m2). ACR, urinary albumin-creatinine ratio (in mg/g).
Figure 2
Figure 2. Spline curve for association of midlife and change in systolic and diastolic blood pressure with late life measured GFR and albuminuria
GFR, glomerular filtration rate. ACR, urinary albumin-creatinine ratio. The two left plots show the associations of systolic (top) and diastolic (bottom) blood pressure with measured GFR. The two right panels show the associations of systolic (top) and diastolic (bottom) blood pressure with albuminuria. The histogram shows the distribution of midlife systolic (top two panels) and diastolic blood pressure (bottom two panels). Albuminuria is expressed as percentage change. Curves are restricted cubic splines with four knots at the default percentiles locations (5%, 35%, 65% and 95%) from the rms package of the R software. These translate to 100, 122, 133, and 157 mm Hg for systolic blood pressure and 70, 79, 85, 99 mm Hg for diastolic blood pressure. There was no statistical evidence of nonlinearity for all relationships. Adjusted values are for the midlife blood pressure were adjusted for age, sex, serum creatinine at midlife, hypertension at midlife, and contemporaneous blood pressure
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References

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