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. 2017 Dec 19;12(12):e0189935.
doi: 10.1371/journal.pone.0189935. eCollection 2017.

Aging and decreased glomerular filtration rate: An elderly population-based study

Affiliations

Aging and decreased glomerular filtration rate: An elderly population-based study

Regina C R M Abdulkader et al. PLoS One. .

Abstract

Background: Although a reduced glomerular filtration rate (GFR) in old people has been attributed to physiologic aging, it may be associated with kidney disease or superimposed comorbidities. This study aims to assess the prevalence of decreased GFR in a geriatric population in a developing country and its prevalence in the absence of simultaneous diseases.

Study design and methods: This is a cross-sectional study of data from the Saúde, Bem-Estar e Envelhecimento cohort study (SABE study[Health, Well-Being and Aging]), a multiple cohorts study. A multistage cluster sample composed of 1,253 individuals representative of 1,249,388 inhabitants of São Paulo city aged ≥60 years in 2010 was analyzed. The participants answered a survey on socio-demographic factors and health, had blood pressure measured and urine and blood samples collected. GFR was estimated and defined as decreased when <60 mL/min/1.73m2. Kidney damage was defined as dipstick-positive hematuria or urinary protein:creatinine > 0.20 g/g.

Results: The prevalence of GFR <60 mL/min/1.73m2 was 19.3%. Individuals with GFR <60 mL/min/1.73m2 were older (75±1 versus 69±1 years, p<0.001), had lower schooling (18 versus 30% with complete 8-year basic cycle, p = 0.010), and higher prevalence of hypertension (82 versus 63%, p<0.001), diabetes (34 versus 26%, p = 0.021), cardiovascular disease (43 versus 24%, p<0.001) and kidney damage (35% versus 15%, p<0.001). Only 0.7% of the entire studied population had GFR <60 mL/min/1.73m2 without simultaneous diseases or kidney damage. Among the individuals with GFR <60 mL/min/1.73m2, 3.5% had neither renal damage nor associated comorbidities, whereas among those with GFR ≥60 mL/min/1.73m2, 11.0% had none of these conditions. Logistic regression showed that older age, cardiovascular disease and hypertension were associated with GFR<60 mL/min/1.73m2.

Conclusions: Decreased GFR was highly prevalent among the geriatric population in a megalopolis of a developing country. It was rarely present without simultaneous chronic comorbidities or kidney damage.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The prevalence of hypertension, diabetes, metabolic syndrome, cardiovascular disease and decreased GFR according to the following age groups: 60–69, 70–79 and ≥80 years.
Data were weighted to be representative of the elderly population of São Paulo based on the 2010 Census in Brazil. Data are presented as weighed percentages. Hypertension: self-reported or the mean of three measurements of arterial blood pressure >140/90 mmHg. Diabetes mellitus: self-reported or a fasting plasma glucose ≥126 mg/dL or a glycohemoglobin ≥6.5%. Metabolic syndrome: presence of at least three of the following criteria: a waist circumference ≥90 cm for men or ≥80 cm for women, triglycerides ≥150 mg/dL, an HDL cholesterol ≤40 mg/dL for males or ≤50 mg/dL for females, a systolic blood pressure ≥130 mm Hg or a diastolic blood pressure ≥85 mmHg and a fasting plasma glucose ≥100 mg/dL. Cardiovascular disease: self-reported. None: absence of hypertension, diabetes, metabolic syndrome or cardiovascular disease. Decreased GFR defined as GFR <60 mL/min/1.73 m2.
Fig 2
Fig 2. Flow-chart showing the weighted percentage of elderly individuals according to the presence of decreased GFR, renal damage and comorbidities.
All the weighted percentages were estimated relative to the entire population, resulting in 100% for each line. Comorb: comorbidities. Decreased GFR defined as GFR <60 mL/min/1.73 m2; renal damage defined as presence of proteinuria/hematuria; comorbidities defined as presence of diabetes, hypertension, metabolic syndrome or cardiovascular disease.

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