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Nondisease-specific problems and all-cause mortality among older adults with CKD: the REGARDS Study.

Publication ,  Journal Article
Bowling, CB; Booth, JN; Gutiérrez, OM; Kurella Tamura, M; Huang, L; Kilgore, M; Judd, S; Warnock, DG; McClellan, WM; Allman, RM; Muntner, P
Published in: Clin J Am Soc Nephrol
October 7, 2014

BACKGROUND AND OBJECTIVES: The term "nondisease-specific" has been used to describe problems that cross multiple domains of health and are not necessarily the result of a single underlying disease. Although individuals with reduced eGFR and elevated albumin-to-creatinine ratio have many comorbidities, the prevalence of and outcomes associated with nondisease-specific problems have not been well studied. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Participants included 3557 black and white United States adults ≥75 years of age from the Reasons for Geographic and Racial Differences in Stroke Study. Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Hazard ratios for mortality over a median (interquartile range) of 5.4 (4.2-6.9) years of follow-up associated with one, two, or three to six nondisease-specific problems were calculated and stratified by eGFR (≥60, 45-59, and <45 ml/min per 1.73 m(2)) and separately, albumin-to-creatinine ratio (<30, 30-299, and ≥300 mg/g). Secondary outcomes included hospitalizations and emergency department visits over 1.8 (0.7-4.0) and 2.3 (0.9-4.7) years of follow-up, respectively. RESULTS: The prevalence of nondisease-specific problems was more common at lower eGFR and higher albumin-to-creatinine ratio levels. Within each eGFR and albumin-to-creatinine ratio strata, the risk for mortality was higher among those with a greater number of nondisease-specific problems. For example, among those with an eGFR=45-59 ml/min per 1.73 m(2), the multivariable adjusted hazard ratios (95% confidence intervals) for mortality associated with one, two, or three to six nondisease-specific problems were 1.17 (0.78 to 1.76), 1.95 (1.24 to 3.07), and 2.44 (1.39 to 4.27; P trend <0.001). Risk for hospitalization and emergency department visits was higher among those with more nondisease-specific problems within eGFR and albumin-to-creatinine ratio strata. CONCLUSIONS: Among older adults, nondisease-specific problems commonly co-occur with reduced eGFR and elevated albumin-to-creatinine ratio. Identification of nondisease-specific problems may provide mortality risk information independent of measures of kidney function.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

October 7, 2014

Volume

9

Issue

10

Start / End Page

1737 / 1745

Location

United States

Related Subject Headings

  • White People
  • Urology & Nephrology
  • United States
  • Time Factors
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Proportional Hazards Models
  • Prognosis
  • Prevalence
  • Multivariate Analysis
 

Citation

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Bowling, C. B., Booth, J. N., Gutiérrez, O. M., Kurella Tamura, M., Huang, L., Kilgore, M., … Muntner, P. (2014). Nondisease-specific problems and all-cause mortality among older adults with CKD: the REGARDS Study. Clin J Am Soc Nephrol, 9(10), 1737–1745. https://doi.org/10.2215/CJN.00880114
Bowling, C Barrett, John N. Booth, Orlando M. Gutiérrez, Manjula Kurella Tamura, Lei Huang, Meredith Kilgore, Suzanne Judd, et al. “Nondisease-specific problems and all-cause mortality among older adults with CKD: the REGARDS Study.Clin J Am Soc Nephrol 9, no. 10 (October 7, 2014): 1737–45. https://doi.org/10.2215/CJN.00880114.
Bowling CB, Booth JN, Gutiérrez OM, Kurella Tamura M, Huang L, Kilgore M, et al. Nondisease-specific problems and all-cause mortality among older adults with CKD: the REGARDS Study. Clin J Am Soc Nephrol. 2014 Oct 7;9(10):1737–45.
Bowling, C. Barrett, et al. “Nondisease-specific problems and all-cause mortality among older adults with CKD: the REGARDS Study.Clin J Am Soc Nephrol, vol. 9, no. 10, Oct. 2014, pp. 1737–45. Pubmed, doi:10.2215/CJN.00880114.
Bowling CB, Booth JN, Gutiérrez OM, Kurella Tamura M, Huang L, Kilgore M, Judd S, Warnock DG, McClellan WM, Allman RM, Muntner P. Nondisease-specific problems and all-cause mortality among older adults with CKD: the REGARDS Study. Clin J Am Soc Nephrol. 2014 Oct 7;9(10):1737–1745.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

October 7, 2014

Volume

9

Issue

10

Start / End Page

1737 / 1745

Location

United States

Related Subject Headings

  • White People
  • Urology & Nephrology
  • United States
  • Time Factors
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Proportional Hazards Models
  • Prognosis
  • Prevalence
  • Multivariate Analysis