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  • Title: [Elderly patients with chronic kidney disease: what happens after 24 months of follow-up].
    Author: Heras M, Fernández-Reyes MJ, Guerrero MT, Sánchez R, Muñoz A, Macías MC, Molina A, Prado F, Alvarez-Ude F.
    Journal: Nefrologia; 2009; 29(4):343-9. PubMed ID: 19668307.
    Abstract:
    INTRODUCTION: Systematic application of mathematical formulae to estimate the glomerular filtration rate (eGFR) of the general population, according to KDOQI classification of Chronic Kidney Disease (CKD), has permitted to calculate its high prevalence, so as to be considered as a public health problem. Many patients with CKD according to this classification (at least stage 3) are elderly with a low GFR and without any other typical manifestations of renal damage, which is generating a worry between nephrologists due to a significant increment in non justified referrals to their clinics. Our aim in this study is to follow-up during twenty-four months a group of elderly with a low eGFR. PATIENTS AND METHODS: 80 clinically stable patients, with a mediane age of 83 years (range 69-97), recruited alleatory in a consultation of Geriatric and Nephrology General, within January and April 2006, were followed up during twenty-four months. We separated them in two groups based in serum creatinine: Group 1: 38 patients with serum creatinine >_ 1,1 mg/dl (range 0,7-1,1), and Group 2: 42 patients with serum creatinine >1.1 mg/dl (range 1,2-3). Clinically we registered morbimortality and treatments received, and biochemically we measured in serum: creatinine and calculated eGFR at the time of recruitment and after twenty-four months of follow-up using two equations: Cockroft and abreviated MDRD. In urine we determinated basic urinalysis in all patients, protein/creatinine in group 1 and determinated protein in collection urine 24 hours group 2. Statistical comparisons were made using repeated measures, chisquare, and logistic regression of the SPSS 11.0 program. RESULTS: 22,5% of the patients died during the follow up. Heart and infectious problems were the kind of morbidity more frequently found. Only a small proportion (23,3%) of group 2 patients were receiving erithropoietin treatment. Estimated GFR and proteinuria remained stable at the end of twenty-four months independently of basal eGFR. We found no significant differences between both groups in the rest of analytical parameters studied except a significant decrease of hematocrit in the elderly of group 2. Only a small proportion (23,3%) of group 2 patients were receiving erithropoietin treatment. CONCLUSION: In old patients without proteinuria, the stability of its renal function along the time allows us to give a soothing message at the moment of facing the so called CKD "epidemic" in this population.
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