Death is much more likely than kidney failure among older patients with stage 4 chronic kidney disease (CKD), particularly those aged 75 years or older and those with cardiovascular disease (CVD), according to a population-based Canadian study.

“For policymakers, this finding suggests that the increase in the number of older adults (the fastest-growing age group) projected for the coming decades worldwide may not translate into a markedly increased prevalence of kidney failure in this population, unlike other age-related conditions such as dementia,” Pietro Ravani, MD, PhD, of the University of Calgary in Alberta, Canada, and colleagues concluded in a paper published in JAMA Network Open.

The investigators examined data recorded from July 30, 2002 to March 31, 2014 from the linked laboratory and administrative data set Alberta Health. The study included 30,801 adults with a mean age of 76.8 years with stage 4 CKD. Of these, kidney failure (defined as the earlier of either renal replacement therapy [RRT] or estimated glomerular filtration rate less than 10 mL/min/1.73 m2) developed in 5511 individuals (17.9%) and 16,285 died (52.9%). The annual incidence of stage 4 CKD did not vary during the study period, but it increased sharply with older age. Approximately 20 new cases per 100,000 person-years were found among individuals younger than 65 years, 250 new cases among those aged 65 to 74 years, 750 new cases among those aged 75 to 84 years, and more than 1500 new cases among those aged 85 years or older. The incidence of kidney failure treated with RRT increased with age less than 84 years (from 100 per million population at age less than 65 years to 750 per million population at age 75 to 84 years) and decreased among individuals aged 85 years or older (250 per million population).

Kidney failure was more likely than death among individuals younger than 65 years, but death was 6 times more likely than kidney failure among those aged 75 to 84 years and 25 times more likely among individuals aged 85 years or older, Dr Ravani’s team reported.


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Among patients with CVD but not diabetes, death was 9.6-fold and 39.5-fold more likely than kidney failure among patients aged 75 to 84 years and those aged 85 years or older, respectively, according to the investigators. Kidney failure was more common than death among patients younger than 65 years regardless of CVD or diabetes status.

“The findings of this study suggest that the increasing burden of severe CKD that accompanies population aging may not translate into increased demand for treatment of kidney failure in older adults,” the authors wrote.

Reference

Ravani P, Quinn R, Fiocco M, et al. Association of age with risk of kidney failure in adults with stage IV chronic kidney disease in Canada. Published online September 18, 2020. I. doi:10.1001/jamanetworkopen.2020.17150