Screening for Chronic Kidney Disease in Older Adults: Evaluating Outcomes and Risk Factors

Core Concepts

Screening for chronic kidney disease in older adults does not significantly impact short-term mortality, hospitalization, or cardiovascular disease outcomes compared to routine diagnosis.

Abstract

The study examined the outcomes of 892 primary care patients aged 60 years or older with chronic kidney disease (CKD) in England. Participants were categorized into three groups: those with existing CKD, those with screen-detected CKD, and those with temporary reduction in kidney function.
The primary outcome was a composite of all-cause mortality, hospitalization, cardiovascular disease, or end-stage kidney disease. The researchers found that the composite outcomes were not significantly different between patients with preexisting CKD and those identified through screening (adjusted hazard ratio 0.94, 95% CI 0.67-1.33).
Additionally, the risks for individual outcomes such as death, hospitalization, cardiovascular disease, or end-stage kidney disease were also not significantly different between the two groups. However, the study identified several risk factors associated with higher mortality, including older age, male sex, and the presence of heart failure.
The study suggests that screening older adults for CKD may be valuable to enable earlier detection and initiation of disease-modifying treatments, despite the lack of significant differences in short-term outcomes between the diagnosed and screen-detected groups.

Stats

Older age (adjusted hazard ratio per year, 1.10; 95% CI, 1.06-1.15) was associated with higher risk of mortality.
Male sex (adjusted hazard ratio, 2.31; 95% CI, 1.26-4.24) was associated with higher risk of mortality.
Heart failure (adjusted hazard ratio, 5.18; 95% CI, 2.45-10.97) was associated with higher risk of mortality.

Quotes

"Our findings show that the risk of short-term mortality, hospitalization, and CVD is comparable in people diagnosed through screening to those diagnosed routinely in primary care. This suggests that screening older people for CKD may be of value to increase detection and enable disease-modifying treatment to be initiated at an earlier stage."

Key Insights Distilled From

Does Screening for CKD Benefit Older Adults?

by Edited Manas... at www.medscape.com 09-27-2024

https://www.medscape.com/viewarticle/does-screening-ckd-benefit-older-adults-2024a1000hji

Deeper Inquiries

What are the potential long-term benefits of early CKD detection through screening in older adults, beyond the short-term outcomes examined in this study?

Early detection of chronic kidney disease (CKD) through screening in older adults can offer several potential long-term benefits that extend beyond the short-term outcomes of mortality, hospitalization, and cardiovascular disease (CVD) events. Firstly, identifying CKD at an earlier stage allows for timely intervention, which can slow the progression of kidney disease. This is crucial as CKD can lead to end-stage kidney disease (ESKD), requiring dialysis or transplantation, both of which are resource-intensive and can significantly impact quality of life.
Secondly, early detection can facilitate the management of comorbid conditions commonly associated with CKD, such as hypertension and diabetes. By implementing lifestyle modifications and pharmacological treatments early, healthcare providers can help mitigate the risk of complications associated with these conditions, ultimately improving overall health outcomes.
Additionally, early screening may enhance patient education and engagement in their health management. Patients who are aware of their CKD status are more likely to adhere to dietary recommendations, medication regimens, and regular follow-up appointments, which can contribute to better long-term health outcomes.
Finally, early detection through screening can lead to a more proactive approach in managing cardiovascular risks, as CKD is a significant risk factor for CVD. By addressing these risks early, healthcare providers can implement preventive strategies that may reduce the incidence of heart attacks and strokes in this vulnerable population.

How might the findings differ in more diverse populations beyond the predominantly White cohort in this study?

The findings of this study may differ significantly in more diverse populations due to variations in genetic predispositions, socioeconomic factors, access to healthcare, and cultural attitudes towards health and disease. For instance, certain ethnic groups may have a higher prevalence of CKD and its risk factors, such as hypertension and diabetes, which could influence the outcomes of screening.
Moreover, the healthcare access disparities prevalent in diverse populations may affect the effectiveness of screening programs. Individuals from minority backgrounds may face barriers such as lack of insurance, transportation issues, or mistrust in the healthcare system, which could lead to delayed diagnosis and treatment of CKD. Consequently, the benefits of early detection through screening might not be as pronounced in these populations if systemic barriers are not addressed.
Additionally, the study's predominantly White cohort may not accurately reflect the risk factors and outcomes experienced by other ethnic groups. For example, certain populations may have different responses to treatment or varying rates of progression to ESKD, which could alter the risk-benefit profile of screening. Therefore, it is essential to conduct further research in diverse populations to understand the implications of CKD screening fully and to tailor interventions that are culturally sensitive and accessible.

What other factors, beyond those identified, could contribute to the increased mortality risk in older adults with CKD, and how might these be addressed through targeted interventions?

In addition to older age, male sex, and heart failure, several other factors could contribute to the increased mortality risk in older adults with chronic kidney disease (CKD). These include:

Comorbidities: The presence of other chronic conditions, such as diabetes, hypertension, and cardiovascular diseases, can exacerbate the progression of CKD and increase mortality risk. Targeted interventions could involve comprehensive management plans that address all comorbidities simultaneously, ensuring that patients receive holistic care.

Nutritional Status: Malnutrition is common in patients with CKD and can significantly impact health outcomes. Addressing nutritional deficiencies through dietary counseling and supplementation can improve overall health and potentially reduce mortality risk.

Mental Health: Depression and anxiety are prevalent among older adults with CKD and can adversely affect treatment adherence and quality of life. Implementing mental health screenings and providing access to psychological support can help manage these issues, leading to better health outcomes.

Social Determinants of Health: Factors such as socioeconomic status, education, and social support networks play a crucial role in health outcomes. Interventions that focus on improving access to healthcare, education about CKD, and community support can help mitigate these risks.

Medication Management: Polypharmacy is common in older adults, and inappropriate medication use can lead to adverse effects and increased mortality. Targeted interventions, such as regular medication reviews and adjustments, can help optimize treatment regimens for CKD patients.

By addressing these additional factors through targeted interventions, healthcare providers can improve the management of CKD in older adults, potentially reducing mortality risk and enhancing quality of life.