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NDT Advance Access originally published online on November 19, 2007
Nephrology Dialysis Transplantation 2008 23(4):1257-1264; doi:10.1093/ndt/gfm792
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Chronic kidney disease prevalence in a UK residential care home population

Joanne L. Carter1, Shelagh E. O’Riordan2, Gillian L. Eaglestone3, Michael P. Delaney3 and Edmund J. Lamb1

1 Departments of Clinical Biochemistry, east Kent Hospitals NHS Trust, Canterbury, Kent, CT1 3NG, United Kingdom 2 Health Care of the Older Person, east Kent Hospitals NHS Trust, Canterbury, Kent, CT1 3NG, United Kingdom 3 Renal Medicine, east Kent Hospitals NHS Trust, Canterbury, Kent, CT1 3NG, United Kingdom

Dr Edmund J. Lamb, Clinical Biochemistry, east Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, United Kingdom. Tel: +44-01227-766877 ext. 74736; Fax: +44- 01227 783077; E-mail: Edmund.lamb{at}ekht.nhs.uk



  Abstract

Background. Chronic kidney disease (CKD) is common (~30%) in non-institutionalized older people but little is known about the prevalence of CKD amongst older people living in residential care.

Methods. An observational study of older subjects [n = 250, median age 86 (range 67–100) years, 79% female, 100% Caucasian, 16% diabetic, 48% hypertensive, 5% known renal disease, mean number of medications 7] who were recruited over a 9-month period from 155 residential care homes in east Kent (total population 3811) using a randomization process. The estimated glomerular filtration rate (eGFR, ml/min/1.73 m2) was calculated using the Cockcroft and Gault equation corrected for the body surface area and the simplified Modification of Diet in Renal Disease (MDRD) Study equation. Serum cystatin C concentration was also measured.

Results. Using the MDRD equation 18% had eGFR ≥60, 39% stage 3A CKD (eGFR 45–59), 34% stage 3B CKD (eGFR 30–44) and 10% stage 4 CKD (eGFR 15–29). By the Cockcroft–Gault equation the equivalent figures were 3%, 18%, 48% and 31%, respectively. Agreement between the equations for staging of CKD was poor ({kappa} = 0.07). However, >80% of residents were categorized as having stage 3 CKD (>40% stage 3B) or worse whichever equation was used. Serum cystatin C concentration was increased in 92% of the population. Increasing age and higher body mass index were predictive of decreased renal function.

Conclusion. Significant CKD is prevalent and unrecognized in this population. This may have important management implications particularly for treatment with renally excreted drugs, fracture prevention or managing cardiovascular risk.

Keywords: chronic kidney disease; cystatin C; glomerular filtration rate; older people; residential care homes

Received for publication: 27. 7.07
Accepted in revised form: 11.10.07


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