Reasons for the Excess Mortality and Functional Decline in Older Adults with CKD

老年 CKD 患者死亡率过高和功能衰退的原因

基本信息

批准号：
8340847
负责人：
Christopher Barrett Bowling
金额：
$ 7.33万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-01 至 2014-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8340847
关键词：
Accounting Activities of Daily Living Address Adult Age Age-Years Aging Alabama Cessation of life Cholesterol Chronic Kidney Failure Communities Data Diabetes Mellitus Dialysis procedure Disease Elderly End stage renal failure Enrollment Excess Mortality Funding Geriatric Assessment Glomerular Filtration Rate Goals Health High Prevalence Hypertension Impaired cognition Incidence Intervention Kidney Kidney Transplantation Lead Life Measures Medicare Mental Depression Mortality Decline National Institute of Neurological Disorders and Stroke Nephrology Outcome Participant Patients Performance Pharmaceutical Preparations Polypharmacy Population Prevalence Reasons for Geographic And Racial Differences in Stroke Recommendation Renal function Research Risk Risk Factors Social Mobility Stroke Universities adverse outcome base beneficiary cardiovascular disorder risk depressive symptoms falls follow-up functional decline geographic difference improved middle age mortality novel patient oriented primary outcome prospective racial difference secondary outcome

项目摘要

DESCRIPTION (provided by applicant): The prevalence and incidence of chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2, increases markedly with age. Yet, the general approach to management of CKD is based on evidence from young and middle-aged adults and may not apply to older adults. This is because at younger ages, CKD is often a progressive disorder and as kidney function worsens patients may develop end-stage renal disease (ESRD) requiring dialysis or kidney transplant. However, over 90% of older adults with CKD die without progressing to ESRD. While the risk of progression to ESRD among patients with CKD may decrease with age, among older adults, CKD is associated with increased mortality and declines in the ability to perform activities of daily living (ADLs) even after adjustment for traditional cardiovascular disease risk factors (e.g. hypertension, high cholesterol, diabetes). Older adults with CKD also have a higher prevalence of geriatric-specific risk factors, defined as conditions that are common among older adults, but not traditionally considered risk factors in CKD patients. These factors are part of the comprehensive geriatric assessment and include cognitive impairment, depression, falls, polypharmacy and poor physical performance. Geriatric-specific risk factors are associated with mortality and functional decline in the general geriatric population and may explain part of the excess mortality and functional decline among older adults with CKD. However, there are few data on the contribution of these factors on the excess mortality and higher rate of functional decline in this population. Therefore, we propose the following specific aims (1) To determine if geriatric-specific factors explain the excess mortality risk among older adults with CKD and (2) To determine if geriatric-specific factors and poor physical performance explain the higher rate of functional decline among older adults with CKD. For Aim 1, we will use data on 7,492 participants ¿ 70 years of age in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study to determine the degree to which each geriatric-specific risk factor accounts for a proportion of the association between CKD and mortality. For Aim 2, we will use data on 400 participants ¿ 69 years of age from the UAB Study of Aging to determine the degree to which each geriatric-specific risk factor and poor physical performance accounts for a proportion of the association between CKD and functional decline. Identifying factors that explain the excess risk for mortality and functional decline associated with CKD in this population is a broad, but necessary first step to achieving our goal to improve "health span" for older adults with CKD. This approach bridges nephrology and aging research using rich and complementary existing data from the REGARDS study and the UAB Study of Aging. The proposed study will determine geriatric-specific risk factors that will lead to patient-centered interventions to reduc risks for mortality and functional decline among older adults with CKD. PUBLIC HEALTH RELEVANCE: Chronic kidney disease (CKD) is more common as people age and associated with increased risk of death or loss of functional abilities. However, prior research has focused on young and middle-age adults with CKD and less is known about CKD in older adults. In the proposed study, we will determine if conditions that are common in older CKD patients such as cognitive impairment, depression, falls, the use of multiple medications and poor physical performance explain why older adults with CKD are more likely to die or have functional decline.

描述（由适用提供）：定义为估计的肾小球滤过率（EGFR）<60 mL/min/1.73m2的慢性肾脏疾病（CKD）的患病率和发病率显着增加。但是，CKD管理的一般方法基于年轻和中年成年人的证据，可能不适用于老年人。这是因为在年轻的年龄，CKD通常是一种进行性疾病，随着肾功能的恶化，患者可能会出现终止肾脏疾病（ESRD），需要透析或肾脏移植。但是，超过90％的CKD老年人死亡而没有发展为ESRD。虽然CKD患者在ESRD的风险中可能随着年龄的增长而降低，但在老年人中，CKD即使在调整了传统的心血管疾病危险因素（例如高血压，高级车马，糖尿病，糖尿病）之后，CKD与执行日常生活活动（ADL）的能力（ADLS）的能力相关。患有CKD的老年人的老年人特异性危险因素的患病率也较高，这定义为在老年人中常见的疾病，但传统上不认为CKD患者的危险因素。这些因素是综合老年评估的一部分，包括认知障碍，抑郁，跌倒，多药和身体表现不佳。老年人群的死亡率和功能下降有关，老年人群的死亡率下降和功能下降有关，并且可以解释CKD老年人的过度死亡率和功能下降的一部分。但是，关于这些因素对过度死亡率和该人群功能下降率较高的贡献的数据很少。因此，我们提出以下特定目的（1）来确定老年人特异性因素是否解释了患有CKD的老年人的过剩死亡风险和（2）来确定老年人特异性因素和身体表现差是否解释了CKD老年人的功能下降率较高。对于AIM 1，我们将使用7,492名参与者的数据»70岁以上的原因是中风和种族差异（有关）研究的原因，以确定每个老年特异性风险因素在CKD和死亡率之间关联的一定比例的程度。对于AIM 2，我们将使用400名参与者的数据»从UAB的衰老研究开始69岁，以确定每个老年特异性危险因素和身体绩效差的程度占CKD和功能下降之间关联的一定比例。确定解释该人群中与CKD相关的死亡率和功能下降风险的因素是一项广泛但必要的第一步，可以实现我们的目标，以改善CKD老年人的“健康跨度”。这种方法使用富裕和互补的现有数据从研究和UAB的衰老研究中桥接肾脏学和衰老研究。拟议的研究将确定老年特异性风险因素，这将导致以患者为中心的干预措施，以降低CKD老年人死亡率和功能下降的风险。公共卫生相关性：随着人们的年龄，慢性肾脏疾病（CKD）更为普遍，并且与死亡或功能能力丧失的风险增加有关。但是，先前的研究集中在年轻和中年成年人中，对老年人的CKD知之甚少。在拟议的研究中，我们将确定在老年CKD患者（例如认知障碍，抑郁症，跌倒，多种药物使用和身体差的情况下）常见的疾病是否解释了为什么患有CKD的老年人更有可能死亡或功能下降。