Ancianos con “enfermedad renal crónica”¿Qué ocurre a los 10 años de seguimiento?

Resum

Introduction: Chronic Kidney Disease (CKD) is a public health problem. Prevalence of low estimated glomerular filtration (eGFR) increases with age. Objectives: 1) to know the evolution of renal function (RF) of living patients; 2) to evaluate the progression to End-Stage-Renal-Disease (ESRD) and/or initiation of renal replacement therapy (RRT); And 3) analyze mortality and its causes. Patients and methods: 80 clinically stable patients, with a median age of 83 years; women: 68,8%; hypertension: 83%; diabetics: 35%; alleatory recruited in the Departments of Geriatric and Nephrology, within January-April 2006, were followed-up for 10 years. We separated them in two groups based in their serum creatinine (sCr) baseline: Group 1: 38 patients with sCr≤1,1 mg/dl (range: 0,7–1,1); and Group 2: 42 patients with sCr>1,1 mg/dl (range: 1,2–3,0). We estimated GFR baseline and 10 years, using abreviated MDRD. Statistical comparisons using repeated measures, SPSS 15.0 program. Results: 61 patients died (Group 1=23, Group 2=38, P=0,003) and 19 patients (including 2 males) with a mean age of 86,47±6 years (range: 79-97) remained in the study. Overall data regarding changes in RF (baseline/10 years) in surviving patients were as follows: sCr (mg/dl): 1,02±0,20/ 1,14±0,91 (not significant [ns]); urea (mg/dl): 43,08±12,0/ 66,16±57,0 (ns); MDRD (ml/min/1.73m2): 60,21±12,0/ 63,33±20,0 (ns). No significant differences in changes in RF by groups. Deterioration of sCr (mg/dl) was higher in proteinuric than not proteinuric patients: 1,25±0,35/ 2,80±2,68 vs 0,99±0,18/ 0,93±0,32, P=0,002. Three patients (Group 2) progressed to ESRD, only one is alive at 10 years. Conclusions: the RF of our surviving patients, without proteinuria, remains stable over time. Elderly patients with worse baseline RF, the risk ESRD is attenuated when an excess of mortality is taken into account. Only proteinuria determinated worse follow-up of RF. Therefore allow us an optimist message for elderly with low eGFR without proteinuria.