#5817 EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE AND COMORBID ILLNESS IN OLDER HOSPITALIZED PATIENTS
Authors: Nastasa Andra , Mahu Gheorghe , Onofriescu Mihai , Apetrii Mugurel , Hussien Hani , Alexa Ioana Dana , Covic Adrian , Nistor Ionut 
Published: June 2023

Abstract

Background and Aims
The number of older people in Europe is expanding. Although chronic kidney disease (CKD) becomes more common with increasing age, data concerning epidemiology of CKD in older people are scarce, especially in Eastern Europe countries. These patients have multiple chronic conditions that must be correctly quantified for guiding risk stratification and subsequent management. Previously, European Renal Best Practice (ERBP) guidelines shed some light on managing older patients with advanced CKD, by stimulating the implementation of validated tools for predicting the most critical risks (death and progression to end-stage renal disease). Risk stratification can further inform decisions about the intensity of care (dialysis versus conservative treatment). In the current analysis, we aimed to fill the gap in CKD epidemiology in older people from Romania by describing a large population of hospitalized geriatric patients.

Method
In this retrospective cohort study, we included all patients aged ≥ 65 years hospitalized in the Geriatric Department of “Dr. C. I. Parhon” Hospital from Iași, Romania, between 2012 – 2022. This Geriatric Unit covers the entire North-East region of the country, so patients are representative of a population of almost 4 million people. CKD was identified as decreased estimated glomerular filtration rate (&lt;60 ml/min/1.73 m2) according to CKD-EPI equation. We investigated comorbid conditions including diabetes mellitus, hypertension/hypertensive heart disease, coronary artery disease, congestive heart failure, atrial fibrillation, chronic respiratory failure and anemia.

Results
3563 geriatric patients (59,2% females) were hospitalized between 2012–2022, totalling 5124 hospital admissions. The most common diagnosis was congestive heart failure (1958 cases, 38,2%) frequently due to hypertensive heart disease (877 patients, 44.8% of CHF cases). 3116 patients (87,4% of the total population) had a serum creatinine assay. Among these patients, the prevalence of CKD using the CKD-EPI equation was 32%. The mean age of CKD patients was 79 years, gender distribution was unequal (63,4% females) and almost half of them (49,1%) had stage 3a CKD. The most frequent comorbidities in patients with CKD were congestive heart failure (33%), diabetes (19%) and hypertension (17%), followed by atrial fibrillation (11%), chronic respiratory failure (9%), coronary artery disease (6%) and anemia (3%). The distribution of CKD patients stratified by the number of comorbidities showed that 86,7% had ≥ 2 comorbidities. The largest CKD subgroup was the one that associated three comorbidities (315 patients, 31.5%), followed by two subgroups that had two comorbidities (249 patients, 24,9%), respectively four comorbidities (189 patients, 18.9%). Only a minority of CKD patients (24 adults, 2,4%) had no other chronic condition.

Conclusion
With the ageing of the population, cardiovascular disease is becoming more common. In our population of geriatric patients, heart failure was the leading cause of hospitalization and the most frequent comorbid condition in CKD patients. One in three adults ≥ 65 years had CKD, a finding similar to other literature data. We emphasized that in older adults, CKD is not an isolated entity, which makes caring for these patients challenging, especially if we add the negative impact of other superimposed geriatric syndromes like frailty and cognitive decline.