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Nephrosclerosis impacts time trajectory of renal function and outcomes in elderly individuals with chronic kidney disease

Maria Teresa Zicarelli, Gemma Patella, Davide Bolignano, Alessandro Comi, Paola Cianfrone, Nicolino Comi, Pierangela Presta, Giorgio Fuiano, Alberto Castagna, Giovanni Ruotolo, Michele Andreucci, Giuseppe Coppolino
DOI: 10.1136/jim-2021-001854 Published 25 November 2021
Maria Teresa Zicarelli
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Gemma Patella
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Davide Bolignano
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Alessandro Comi
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Paola Cianfrone
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Nicolino Comi
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Pierangela Presta
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Giorgio Fuiano
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Alberto Castagna
2 Geriatric Department, ASP Catanzaro, Catanzaro, Calabria, Italy
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Giovanni Ruotolo
3 Department of Medicine, Pugliese Ciaccio Hospital, Catanzaro, Calabria, Italy
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Michele Andreucci
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Giuseppe Coppolino
1 Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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Abstract

Despite hypertension ranks among the leading causes of chronic kidney disease (CKD), the impact of chronic hypertensive nephropathy, the so-called ‘nephrosclerosis’ (NS), on CKD progression is often unpredictable, particularly in elderly population. We have conducted a prospective, observational study to define renal function patterns and outcomes in elderly CKD individuals with or without NS. Three hundred four individuals with an already established CKD were categorized according to the etiology of CKD. NS was defined as the presence of CKD associated with long-term essential hypertension, hypertensive retinopathy, left ventricular hypertrophy and minimal proteinuria. Time trajectories in estimated glomerular filtration rate (eGFR) (CKD-Epi) were computed over a 4-year follow-up. In addition, we analyzed the occurrence of a composite outcome of doubling of serum creatinine levels, eGFR reduction ≥25% and/or the need of chronic renal replacement therapy. CKD was secondary to nephrosclerosis (CKD-NS) in 220 (72.3%). In the whole cohort, the average estimated annual GFR slope was 1.8 mL/min/1.73 m2. eGFR decline was slower in CKD-NS as compared with others (1.4 vs 3.4 mL/min/1.73 m2; p<0.001). The composite renal outcome during follow-up occurred less frequently among elderly with CKD-NS (16/204 vs 14/70; p=0.01, crude HR 0.43, 95% CI 0.22 to 0.85) and was associated at logistic analyses with the etiology of CKD, background cardiovascular disease, total and low density lipoproteins (LDL) cholesterol, and glycemia levels (p value was ranging from 0.01 to 0.05). Despite being highly prevalent in the elderly, NS is associated with a more favorable renal disease course as compared with other conditions.

Footnotes

  • MTZ and GP contributed equally.

  • Contributors All authors contributed to the conceptualization, design, data collection, interpretation, and preparation of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Vol 69 Issue 8 Table of Contents
Journal of Investigative Medicine: 69 (8)
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Nephrosclerosis impacts time trajectory of renal function and outcomes in elderly individuals with chronic kidney disease
Maria Teresa Zicarelli, Gemma Patella, Davide Bolignano, Alessandro Comi, Paola Cianfrone, Nicolino Comi, Pierangela Presta, Giorgio Fuiano, Alberto Castagna, Giovanni Ruotolo, Michele Andreucci, Giuseppe Coppolino
Journal of Investigative Medicine Dec 2021, 69 (8) 1411-1416; DOI: 10.1136/jim-2021-001854

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Nephrosclerosis impacts time trajectory of renal function and outcomes in elderly individuals with chronic kidney disease
Maria Teresa Zicarelli, Gemma Patella, Davide Bolignano, Alessandro Comi, Paola Cianfrone, Nicolino Comi, Pierangela Presta, Giorgio Fuiano, Alberto Castagna, Giovanni Ruotolo, Michele Andreucci, Giuseppe Coppolino
Journal of Investigative Medicine Dec 2021, 69 (8) 1411-1416; DOI: 10.1136/jim-2021-001854
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Nephrosclerosis impacts time trajectory of renal function and outcomes in elderly individuals with chronic kidney disease
Maria Teresa Zicarelli, Gemma Patella, Davide Bolignano, Alessandro Comi, Paola Cianfrone, Nicolino Comi, Pierangela Presta, Giorgio Fuiano, Alberto Castagna, Giovanni Ruotolo, Michele Andreucci, Giuseppe Coppolino
Journal of Investigative Medicine Dec 2021, 69 (8) 1411-1416; DOI: 10.1136/jim-2021-001854
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