Chronic Kidney Disease (CKD) among older people across Europe: findings from cross-sectional analysis of SCOPE H2020 project

In this blog, Supplement Editor Fabrizia Lattanzio discusses findings from the Screening for Chronic Kidney Disease among Older People across Europe (SCOPE) project published in BMC Geriatrics, which aims to compare different screening methods for CKD within older populations.

Chronic kidney disease (CKD) is defined as the presence of lasting functional abnormalities in the renal structure and function that can worsen over time. Kidneys are vital for the whole body to work properly. Therefore, when a person has CKD, they may also have problems with the functioning of the rest of their body.  Some of the common complications of CKD include anemia, bone disease, heart disease, high potassium, high calcium and fluid accumulation.

CKD is an important public health problem worldwide, especially in older people, and it is associated with a huge economic burden. High income countries generally spend more than 2-3% of their annual budget on the treatment of end-stage renal disease, although people receiving such treatments represent less than 0.03% of the total population.

Although the prevalence of CKD is increasing and the importance of early diagnosis to prevent complications such as end-stage renal disease (ESRD) is well established, screening programmes in Europe are highly heterogeneous and fragmented. Health system planning requires careful evaluation of the epidemiology of CKD, but data on morbidity and mortality of this disease are scarce or non-existent in many countries.

The SCOPE (Screening for CKD among older people across Europe) H2020 project implemented in  seven European Countries plus Israel includes an observational prospective study with a 2-year follow up, recruiting 2426 older people aged 75+, to investigate whether and to which extent currently available screening methods may identify older people at risk of worsening kidney function.

Preliminary results from the baseline database of the SCOPE Project was made available in the BMC Geriatrics Special Issue by Dr Fabrizia Lattanzio et al.

CKD and Quality of Life

Quality of life (QoL) refers to the physical, psychological, social, and medical aspects of life that are influenced by health status and functions. The SCOPE team investigated the QoL among older in early stage of CKD, to identify the factors that influence this relationship. The study results showed that CKD and its severity may be significantly associated with impaired QoL among community-dwelling older people.

Is kidney function associated with cognition and mood in late life?

The prevalence of CKD and cognitive impairment is growing as a result of the aging population. CKD, cognitive impairment, and mood disorder share common risk factors. Whether a decreased kidney function is associated with cognitive and mood disorders in the oldest old is not completely clear. Therefore, the SCOPE team has investigated for the first time the possible association between kidney function, cognition and mood. The study results showed that the prevalence of cognitive impairment and depressive symptoms  does not increase among older people in more advanced stages of CKD.

Is CKD a predictor of falls?

Falls are a serious negative health outcome in older persons. In facts, the fall rate rises with increasing age. However, the impact of CKD on falls in older community-dwelling persons is not well investigated yet, especially in relation to the urinary tract symptoms (LUTS). The SCOPE team studied the impact of CKD and LUTS on falls as well as on injurious falls. The study results showed that lower urinary tract symptoms are a predictor of falls and injurious falls, while the association between CKD and falls needs to be prospectively investigated.

CKD and sarcopenia

Loss of muscle mass and function (sarcopenia) may be more pronounced in older adults with CKD, wherein the protein albumin is abnormally present in the urine (albuminuria). The SCOPE team investigated the prevalence of sarcopenia among community-dwelling older adults according to kidney function and albuminuria levels. The study results showed that sarcopenia is common among older adults, especially those in more advanced CKD stages, even if the estimated prevalence slightly differs depending on the equation used to assess estimated Glomerular Filtration Rate (eGFR); likewise, sarcopenia seems to be widespread among older people with higher albuminuria levels.

Association between kidney function and nutritional status

Different mechanisms connect the nutritional status with the occurrence and the course of CKD. Existing literature shows that especially during end-stage renal disease, there are complications that lead to malnutrition (undernutrition). However, the SCOPE team has further investigated this relationship between kidney function and nutritional status. The study results showed that population of community-dwelling 75+ with CKD show general features of overweight and obesity with a small prevalence of malnutrition.

CKD in multimorbidity patterns

CKD is known to be associated with several co-occurring conditions. The SCOPE team has explored multimorbidity patterns, as well as the impact of physical performance and CKD severity among an older community-dwelling people. The study results showed that CKD contributes significantly to multimorbidity patterns in a population of older outpatients and it was rarely observed without any co-occurring diseases. Moreover, CKD may cluster with hypertension and sensory impairments, but its contribution to multimorbidity pattern may be affected by CKD severity.

These scientific results prompt to further improve the screening methods for CKD in the older population and the models of assistance and care through longitudinal studies. The early diagnosis of CKD represents a priority issue to be addressed to prevent / slow its progression among older patients and, at the same time, to reduce the need for long-term care and the related cost for the healthcare system.

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