Prevalence and determinants of chronic kidney disease among community-dwelling adults, 50 years and older in Ireland

Abstract

Background: Using the Irish Longitudinal Study on Ageing (TILDA), we evaluated the prevalence and distribution of chronic kidney disease (CKD), and its determinants in order to identify risk groups for population health planning in Ireland.

Methods: Data were analysed from Wave 1 (2009-2011) of the TILDA, a national cohort of participants aged 50+ years who had both plasma creatinine and cystatin C measured at baseline. Kidney function was estimated using the 2012 and 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m². Multivariable logistic regression explored associations using adjusted odds ratios (OR).

Results: Prevalence of CKD was significantly higher using the CKD-EPI 2012_(Scr-CysC) compared with the CKD-EPI 2021_(Scr-CysC) (14.7% vs 11.3%, respectively). The prevalence was highest in patients with cardiovascular disease (CVD) (33.9%), diabetes (28.0%), cancer (25.5%), urinary incontinence (23.7%), bone diseases (21.5%), hypertension (19.8%) and obesity (19.5%). In multivariable analysis, individuals with hypertension (OR 1.78), diabetes (OR 1.45), CVD (OR 1.43), cancer (OR 1.53), overweight (OR 1.37) and obesity (OR 2.33) experienced greater likelihood of CKD. In addition, individuals with a history of previous hospitalization (OR 1.50), free or subsidized healthcare (OR 1.31), and unemployed individuals (OR 1.86) were also significantly more likely to have CKD.

Conclusion: Compared with the national average, the burden of CKD is far greater in older individuals with major chronic conditions and socioeconomic deprivation. The identification and targeting of these groups through national surveillance programmes is likely to yield substantial benefits from more effective disease management and proactive population health planning.

Keywords: chronic kidney disease; comorbid condition; prevalence; risk factor; social deprivation.

Graphical Abstract

Figure 1:

Strobe diagram of study participants from the TILDA cohort aged >50 years and older who completed a computer-assisted face-to-face interview in their home, a self-complete postal questionnaire and a centre- or home-based health assessment and have has serum creatinine and cystatin C measurements.

Figure 2:

Crude and weighted prevalence of CKD among participants age >50 years provided by CKD-EPI 2012_(Scr-CysC), CKD-EPI 2021_(Scr-CysC) (race-free) and age-adapted equations The weighted values account for sample design complexities to provide a more accurate representation of the community-dwelling population aged 50 years and over.

Figure 3:

Weighted prevalence of CKD by age and sex using CKD-EPI 2012_(Scr-CysC) and CKD-EPI 2021_(Scr-CysC) equations. The asterisk indicates that the CKD-EPI 2021_(Scr-CysC) equation is race-free and P-value between age groups is <.001 for both equations, and between men and women is <.001 for CKD-EPI 2012_(Scr-CysC) and .015 for CKD-EPI 2021_(Scr-CysC) equations.

Figure 4:

The AUC-ROC comparing logistic regression models’ performance to determine factors associated with CKD. The curves illustrate the sensitivity versus specificity for each model, with the AUC values indicating the model performance. Model 1 (blue) achieved an AUC of 0.84, Model 2 (red) achieved an AUC of 0.85 and Model 3 (green) achieved an AUC of 0.86. The diagonal line represents the line of no-discrimination, where the model performs no better than random chance.