Characteristic features of polymorbid pathology in elder and senile patients with chronic kidney disease

Objective: to study the prevalence and characteristics of polymorbid pathology in elderly and senile patients with chronic kidney disease in outpatient practice.

Materials and methods. A cross-sectional study of 787 CKD patients was conducted: 630 elderly patients (median age 67 years) and 157 senile patients (median age 77 years). BMI, GFR by CKD-EPI formula, proteinuria, comorbidities, lipid profile, and CKD awareness were assessed.

Results. Obesity was detected in 53.2% of elderly and 46.1% of senile patients. Arterial hypertension was diagnosed in 84.3% and 93.6%, diabetes mellitus in 85.6% and 92.4%, respectively. CKD stages C2 (51.3% and 46.2%) and C3 (23.5% and 40.2%) were most common. CKD awareness was only 10.6% in the first group and 21.0% in the second. Only 26% and 22.9% of patients received nephrological consultation, respectively.

Conclusion. Elderly and senile patients with CKD demonstrate high prevalence of cardiovasculorenal metabolic risk factors with critically low awareness of kidney disease and insufficient nephrological control. 

1. 1 Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, White HD, Nordlander R, Maggioni A, Dickstein K, Zelenkofske S, Leimberger JD, Califf RM, Pfeffer MA. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004 Sep 23;351(13):1285-95. https://doi.org/10.1056/NEJMoa041365 PMID: 15385655.

2. 2 Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS. Prevalence of chronic kidney disease in the United States. JAMA. 2007 Nov 7;298(17):2038-47. https://doi.org/10.1001/jama.298.17.2038 PMID: 17986697.

3. 3 Rule AD, Amer H, Cornell LD, Taler SJ, Cosio FG, Kremers WK, Textor SC, Stegall MD. The association between age and nephrosclerosis on renal biopsy among healthy adults. Ann Intern Med. 2010 May 4;152(9):561-7. https://doi.org/10.7326/0003-4819-152-9-201005040-00006

4. 4 Tannor E.K., Norman B.R., Adusei K.K., et al. Quality of life among patients with moderate to advanced chronic kidney disease in Ghana – a single centre study. BMC Nephrology. 2019; 20(122): 1-10. https://doi.org/10.1186/s12882-019-1316-z

5. 5 Rangaswami J, Bhalla V, Blair JEA, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2019;139:e840e878. https://doi.org/10.1161/CIR. 0000000000000664

6. 6 Tuttle KR, Agarwal R, Alpers CE, et al. Molecular mechanisms and therapeutic targets for diabetic kidney disease. Kidney Int. 2022;102:24860. https://doi.org/10.1016/j.kint.2022.05.012

7. 7 Suplotova L.A., Alieva O.O., Dushina T.S., Makarova O.B. Obesity in the elderly: peculiarities of treatment in outpatient practice. Obesity and metabolism. 2023;20(2):140-148. (In Russ.) https://doi.org/10.14341/omet12919

8. 8 Dedov I. I., Melnichenko G. A., Shestakova M. V., Troshina E. A., Mazurina N. V., Shestakova E. A., Fadeev V. V. National clinical guidelines for the treatment of morbid obesity in adults. 3rd revision (treatment of morbid obesity in adults). Obesity and metabolism. 2018;15(1):53-70. (In Russ.) https://doi.org/10.14341/omet2018153-70

9. 9 Nasaif H., Alaradi M., Hammam R. Prevalence of overweight and obesity among nurses in Bahrain: A cross‐sectional study. Nursing Open. 2024;11(1):e2090. https://doi.org/10.1002/nop2.2090

10. 10 Phelps N.H., Singleton R.K., Zhou B., Heap R.A., Mishra A., Bennett J.E., Barbagallo C.M. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024 С. S0140-6736 (23) 02750-2. https://doi.org/10.1016/S0140-6736(23)02750-2

11. 11 Dedov I. I., Mokrysheva N. G., Melnichenko G. A., Troshina E. A., Mazurina N. V., Ershova E. V., Yashkov Yu. I. Obesity. Consilium Medicum. 2021;23(4):311-325. https://doi.org/10.26442/20751753.2021.4.200832

12. 12 Griffin KA, Kramer H, Bidani AK. Adverse renal consequences of obesity. American journal of physiologyRenal physiology. 2008;294(4):F685–96.

13. 13 Chang AR, Grams ME, Ballew SH, Bilo H, Correa A, Evans M, et al. Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium. Bmj. 2019;364:k5301.

14. 14 El Bizri I, Batsis JA. Linking epidemiology and molecular mechanisms in sarcopenic obesity in populations. Proc Nutr Soc. 2020;79(4):448456. https://doi.org/10.1017/S0029665120000075

15. 15 Wang M, Tan Y, Shi Y, et al. Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments. Front Endocrinol (Lausanne). 2020;11. https://doi.org/10.3389/fendo.2020.00568

16. 16 Jiang Z, Wang Y, Zhao X, Cui H, Han M, Ren X, Gang X, Wang G. Obesity and chronic kidney disease. Am J Physiol Endocrinol Metab. 2023 Jan 1;324(1):E24-E41. https://doi.org/10.1152/ajpendo.00179.2022 Epub 2022 Nov 16. PMID: 36383637.

17. 17 Dobronravov V.A., Bystrova N.N., Drozdova Yu.V. Assessment of kidney dysfunction in patients with diabetes mellitus. Nephrology. 2007;11(3):7-11.

18. 18 Daly C. Is early chronic kidney disease an important risk factor for cardiovascular disease? A background paper prepared for the UK Consensus Conference on early chronic kidney disease. Nephrol Dial Transplant. 2007 Sep;22 Suppl 9:ix19-25. https://doi.org/10.1093/ndt/gfm445

19. 19 Batyushin M.M. Chronic kidney disease: the current state of the problem. Rational Pharmacotherapy in Cardiology. 2020;16(6).

20. 20 BatIushin M.M., Kasimova I.S., Gavrilov D.V. et al. The prevalence of chronic kidney disease according to the data of the retrospective cohort study "epidemiology of CKD" (Kirov). Nephrology and dialysis. 2021;23(2):192-202. (In Russ.) https://doi.org/10.28996/2618-9801-2021-2-192-202

21. 21 Dedov I. I., Shestakova M. V., Melnichenko G. A., Mazurina N. V., Andreeva E. N., Bondarenko I. Z., Sheremetyeva E. V. Interdisciplinary clinical guidelines "Treatment of obesity and comorbid diseases". Obesity and metabolism. 2021;18(1):5-99. (In Russ.) https://doi.org/10.14341/omet12714