PTH levels and not serum phosphorus levels are a predictor of the progression of kidney disease in elderly patients with advanced chronic kidney disease

摘要

Background At present, there is a high incidence of elderly patients with advanced chronic kidney disease (CKD) and it is important to know the long term progression and the factors that influence it. Objectives To analyse the progression of advanced CKD in elderly patients and the influence of bone-mineral metabolism. Methods Retrospective study of 125 patients ≥70 years of age with CKD stages 4–5 who started follow-up from January 1, 2007 to December 31, 2008, showing the progression of CKD (measured by the slope of the regression line of the estimated glomerular filtration rate [eGFR] by MDRD-4) over 5 years. Results Progression in the entire group (median and 25th and 75th percentiles): ?1.15 (?2.8/0.17) ml/min/1.73 m 2 /year, CKD-4: ?1.3 (?2.8/0.03) ml/min/1.73 m 2 /year, CKD-5: ?1.03 (?3.0/0.8) ml/min/1.73 m 2 /year; the slope of the regression line was positive in 35 patients (28%: CKD does not progress) and negative in 90 patients (72%: CKD progresses). Negative correlation (Spearman) (slower progression): PTH, albumin/Cr ratio and daily Na excretion (all baseline measurements). No correlation with eGFR, serum P, urinary P excretion, protein intake and intake of P (all baseline measurements). In the linear regression analysis (dependent variable: slope of progression): albuminuria and PTH (both at baseline measurements) influenced this variable independently. Logistic regression (progresses vs. does not progress): PTH, albuminuria and eGFR (all at baseline measurements) influenced significantly. Conclusions In our group of elderly patients, impairment of renal function is slow, particularly in CKD-5 patients. Albuminuria and PTH at baseline levels are prognostic factors in the evolution of renal function.