Chronic kidney disease in the elderly: A clinical profile and assessment of disease progression in patients attending renal clinics at tertiary hospitals in Johannesburg, South Africa

Abstract

Introduction: Chronic kidney disease (CKD) in the elderly population is common in clinical practice. There are a number of known traditional risk factors associated with CKD progression such as diabetes mellitus, hypertension and proteinuria amongst others. In an elderly cohort from Chris Hani Baragwanath Academic (CHBAH) and Charlotte Maxeke Johannesburg Academic (CMJAH) hospitals these factors were assessed to determine their relationship to CKD and its progression. Methods: The purpose of this study was to assess the clinical profile and assess factors associated with CKD progression in elderly patients. A retrospective observational study was performed on 195 elderly patients aged 60-80 years with CKD that attended renal outpatient clinics for a minimum 2 years between 1 January 2010 - 31 December 2018 at CMJAH and CHBAH. Socio-demographics, co- morbidities, biochemical characteristics and aetiologies of CKD (recorded and determined by treating clinicians) were described as proportions. Factors associated with progression of CKD were determined using multivariate logistic regression analysis. Results: In a predominantly black population with mean age 66±5years, and M:F ratio 1,4:1 hypertension (94.4%), diabetes mellitus (46.2%) and dyslipidaemia (51.3%) were the leading comorbidities. Diabetes was controlled (HBA1c <7%) in 37 (44%) patients at baseline; blood pressure was controlled (<140/90mmHg) in 62 (31.7%) patients by the end of the second year. Diabetes mellitus was the commonest comorbidity of CKD among progressors. Kidney function declined in 97 (49.7%) patients. The progression rate was -4.8ml/min/1.73m2 and -5.98ml/min/m2 in the first and second years of the study. Anaemia was an independent predictor of CKD progression (OR = 1.493, 95% CI: 1.26-1.95, p =0.034). Polypharmacy was observed in 74% of patients. 10 Conclusion: Poorly controlled hypertension and diabetes mellitus are common comorbidities in elderly patients with CKD. Anaemia in CKD was independently associated with progression of disease.