[28–30,33] In a recent adult population-based study in Iran the prevalence of CKD was 23.7%. https://doi.org/10.1371/journal.pone.0189935.s001. [39] We did not assess other possibilities that may be related to decreased GFR (e.g., use of nephrotoxic drugs), although we assessed a larger number of comorbidities than previous studies. A third follow-up visit was made in 2010 when a new sample of individuals 60–64 years was included. The few population–based studies designed specifically to assess the elderly population have shown great diversity with respect to CKD prevalence, ranging from 23.4 to 58.5%. [17] All participants were classified as non-African-American. We observed a higher prevalence of decreased GFR than two other population-based Brazilian studies. 540 0 obj <>/Filter/FlateDecode/ID[<3C65A80465DA8A43AB6B6B42FC5900A3><22F74D9448C38C4EBB779CE61349154F>]/Index[522 26]/Info 521 0 R/Length 96/Prev 181225/Root 523 0 R/Size 548/Type/XRef/W[1 3 1]>>stream Diabetes mellitus: self-reported or a fasting plasma glucose ≥126 mg/dL or a glycohemoglobin ≥6.5%. In this figure, all weighted percentages were estimated relative to the entire population, resulting in 100% for each line. Comorb: comorbidities. After the dipstick reading, the urine samples were kept in -20°C freezer until the creatinine and protein were measured. Forty nine percent perceived their health as good or very good, and 50.8% had never smoked. Kidney damage was defined as dipstick-positive hematuria or urinary protein:creatinine > 0.20 g/g. Yes The Wald test was used to evaluate the statistical significance of the association between independent and dependent variables. No, Is the Subject Area "Diabetes mellitus" applicable to this article? Data were obtained by an interviewer-administered questionnaire at the participants’ homes and included information on socio-demographic factors, general health and living conditions. None: absence of hypertension, diabetes, metabolic syndrome or cardiovascular disease. University of São Paulo Medical School, São Paulo, Brazil, Roles Conceptualization, The goal of Fisheries management is to produce sustainable biological, social, and economic benefits from renewable aquatic resources. We used anthropometric and laboratory measurements in addition to questionnaires when analyzing comorbidities. In the second phase, the dwellings were selected by simple random sampling, with a minimum of 90 in each sector. [5] When a disease superimposes on aging, GFR decline and other signs, such as proteinuria, may appear. Regina C. R. M. Abdulkader, Dependent variable was decreased GFR (reference absence) and independent variables were age (70-79/80-89/≥90 years, reference 60–69 years) and presence of diabetes, hypertension or cardiovascular disease (reference absence), adjusting for sex, schooling and monetary income. Complete data for the 1253 individuals who entered the study of decreased GFR are shown in S1 File. Participation was voluntary, and written informed consent was obtained. Even the Berlin Initiative Study (BIS) which analyzed the risk factors for decreased GFR and albuminuria did not reported the prevalence of individuals with GFR<60 mL/min/1.73 m2 without comorbidities. Descriptive analysis was carried out. Fibrinogen (374±6 versus 341±4 ng/dL, p<0.001), urinary protein:creatinine ratio (0.24±0.05 versus 0.06±0.01 g/g, p<0.001) and presence of renal damage (35.2 versus 14.9%, p<0.001) were higher in the decreased GFR group. These data suggest that a decreased GFR in the elderly is strongly indicative of the presence of concomitant renal disease, which should be investigated. Glomerular filtration rate decreases with aging, but studies examining whether this process is physiological or pathological have yielded conflicting results. No, Is the Subject Area "Brazil" applicable to this article? The elderly had their cognitive status evaluated by the Mini Mental State Examination (MMSE, validated for the SABE Study). [21] The analysis incorporated the individuals’ weights to correct for the different selection probabilities of participants and for the data to be representative of the population of São Paulo city aged ≥60 years. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model. The frequency of renal damage increased with the decrease of GFR: 14.0% for GFR ≥ 90 mL/min/1.73m2, 15.2% for GFR 89–60 mL/min/1.73m2; 23.3% for GFR 59–45 mL/min/1.73m2, 24.4% for GFR 44–30 mL/min/1.73m2, 44.4% for GFR 29–15 mL/min/1.73m2 and 100% for GFR < 15 mL/min/1.73m2. Categorical data are presented as weighted percentages, and continuous variables, as weighted means and standard errors. [28–31] In this study, we considered a GFR < 60 ml/min/1.73m2 as decreased GFR (not CKD) and an abnormal urinalysis or proteinuria as renal damage. The total sample included in 2010 was 1344 individuals aged ≥ 60 years which represented 1,338,138 elderly individuals living in São Paulo city. The cutoff of GFR <60 mL/min/1.73m2 to diagnose decreased GFR may result in an error of approximately 9%. All the weighted percentages were estimated relative to the entire population, resulting in 100% for each line. All of these tests were performed at the laboratory of INCOR (Heart Institute, School of Medicine, University of São Paulo), which is certified by ISO 9001. The objectives of the present study are to estimate the prevalence of decreased GFR in the elderly population of São Paulo city and the frequency of decreased GFR without simultaneous comorbidities. The dipstick was read manually by a trained professional following instructions provided by the manufacturer. Among those with GFR<60 mL/min/1.73 m2, the proportion of individuals without renal damage or associated comorbidities was more than three-fold less than among those with GFR ≥ 60 mL/min/1.73 m2 without these associated conditions. Yes A positive dipstick test for urine hemoglobin or an abnormal proteinuria (urinary protein:creatinine ratio > 0.20 g/g) was classified as kidney damage. h�b```�,|� ���� The number of people over 80 will also triple to almost 6% of the population. 0 [32] Most of the population-based studies on CKD prevalence have evaluated adults in general and have shown a strong positive influence of age on CKD prevalence in several countries, such as China, the UK, Ireland, the Netherlands and the USA. These are the last population estimates before results of the 2020 decennial census are released. The following anthropometric variables were considered: systolic and diastolic blood pressure (mean of three measurements in the same visit, mmHg); waist circumference (cm), height (m) and weight (kg) measurements. Most of them went to school (88.5%), but only 28% had completed the 8-year basic cycle, and 87.1% had an income < 4 minimum wage/month. Hawaii Population Characteristics 2019 The U.S. Census Bureau released the 2019 State and County population characteristics on June 25, 2020. Yes No, Is the Subject Area "Geriatric nephrology" applicable to this article? Among those lost to follow up, 930 had died, 300 were not found or had moved from the city, 21 were institutionalized and 212 refused to participate in the continuation of the study. Our study has some limitations. [22] The package offers procedures for analysis of complex sample inquiries and allows the incorporation of different weights of observations that influence the parameter estimates of the total population and the effect of sampling on variance estimates. A normal BMI was found in 34.3% of the population, with 57.6% being overweight or obese and 8.1% having a low BMI. Click through the PLOS taxonomy to find articles in your field. Metabolic syndrome: presence of at least three of the following criteria: a waist circumference ≥90 cm for men or ≥80 cm for women, triglycerides ≥150 mg/dL, an HDL cholesterol ≤40 mg/dL for males or ≤50 mg/dL for females, a systolic blood pressure ≥130 mm Hg or a diastolic blood pressure ≥85 mmHg and a fasting plasma glucose ≥100 mg/dL. https://doi.org/10.1371/journal.pone.0189935.t001. [11] None of these studies investigated the presence of kidney disease in individuals with decreased GFR or abnormal SCr. Competing interests: The authors have declared that no competing interests exist. The participants answered a survey on socio-demographic factors and health, had blood pressure measured and urine and blood samples collected. In a systematic review of population-based studies, the median prevalence of CKD was 7.2% in people aged ≥ 30 years, but it ranged from 23.4% to 35.8% in people aged ≥ 64 years. The study was approved by the Human Research Ethics Committee of the School of Public Health, University of São Paulo (OF.COEP 23/10). Data Availability: All relevant data are within the paper and its Supporting Information file. The presence of a GFR<60 mL/min/1.73 m2 was likely not associated with undernutrition or muscle wasting because BMI values were similar to those among individuals with GFR ≥60 mL/min/1.73 m2. [19] Metabolic syndrome was defined as having at least three of the following criteria: waist circumference ≥ 90 cm for men or ≥ 80 cm for women, triglycerides ≥ 150 mg/dL, HDL cholesterol ≤ 40 mg/dL for males or ≤ 50 mg/dL for females, systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg, and FPG ≥ 100 mg/dL. According to the national surveillance on the elderly in Vietnam (VNAS) conducted in 2011, over half of the elderly (56%) self-assessed their health conditions as weak (49.4%) and very weak (6.7%). [1] This dissimilarity may be partially explained by the use of different equations to estimate GFR (there is no consensus as to which one is the best equation for the elderly). [37–38] We didn’t have access, for economic reasons, to the calibrated SCr used in the newer equations or to albuminuria to classify renal damage. [3] The estimated prevalence of patients on chronic dialysis in Brazil in 2012 was 503 per million, with 31.9% aged ≥ 65 years. [26], The Kidney Disease: Improving Global Outcomes (KDIGO) practice guidelines define CKD as a GFR < 60 ml/min/1.73m2 or the presence of kidney damage (abnormal urinalysis, kidney imaging, or renal biopsy) that persists for ≥ 3 months. Although a reduced glomerular filtration rate (GFR) in old people has been attributed to physiologic aging, it may be associated with kidney disease or superimposed comorbidities. The American Community Survey Statewide and County Aging Profiles, 2015-19 These three files linked below contain demographic, economic and social information about the older population for every Wisconsin county and the state as a whole. The population is aging in many countries, especially Japan, meaning that there are increasing numbers of elderly people to care for, but relatively fewer young people to care for them. Yes Writing – original draft. According to Organisation for Economic Co-operation and Development (OECD)/World Bank, the population in Canada increased from 1990 to 2008 with 5.6 million and 20.4% growth in population, compared to 21.7% growth in the United States and 31.2% growth in Mexico.According to the OECD/World Bank population statistics, for the same period the world population … Data are presented as weighed percentages. Roles Since only once the renal function was evaluated, we couldn´t classify, according to KDIGO guidelines, the individuals who had GFR <60 mL/min/1.73m2 as having CKD. Urine samples were collected in the morning and kept cold until the dipstick reading to detect the presence of hemoglobin (one + or more was considered positive). [12–13] Briefly, in the first phase in 2000, census sectors were selected for sampling with probability proportional to the number of dwellings in each sector. Yes The SCr was analyzed using the Jaffé method (reference values: 0.8–1.3 mg/dL for males and 0.6–1.0 mg/dL for females). It was specifically designed to address the following question: “is the frequency of decreased GFR in the elderly attributable to only the physiological aging process?” Our study was also designed to obtain a representative sample of the elderly population of São Paulo at the time the study was conducted. No, Is the Subject Area "Cardiovascular diseases" applicable to this article? Funding acquisition, GFR < 60 mL/min/1.73m2 was present in 19.3% of the individuals, who were older than those with GFR ≥ 60 mL/min/1.73m2 (75.3±0.9 versus 69.3±0.7 years, p<0.001). [10] Another Brazilian study reported that, among 822 participants aged ≥ 60 years (a simple random sampling among 9,009 elderly inhabitants of Tubarão city enrolled in the Family Healthcare Strategy Program), 112 (13.6%) had an estimated GFR < 60 mL/min/1.73m2. Chronic kidney disease (CKD) is a public health problem worldwide. Yes Cardiovascular disease: self-reported. Among the individuals with GFR <60 mL/min/1.73m2, 3.5% had neither renal damage nor associated comorbidities, whereas among those with GFR ≥60 mL/min/1.73m2, 11.0% had none of these conditions. [10–11] The Bambui study observed a prevalence of increased SCr (single measurement) of 5.1%, whereas our study found a prevalence of 16.2% (data not shown). %PDF-1.6 %���� The following tests were assessed in fasting blood samples: urea (mg/dL), SCr (mg/dL), calcium (mEq/L), phosphorus (mg/dL), albumin (g/dL), uric acid (mg/dL), hemoglobin (g/dL), iron (μg/dL), ferritin (ng/dL), C-reactive protein (CRP, mg/dL), fasting plasma glucose (FPG, mg/dL), glycohemoglobin (HbA1c, %), cholesterol and its HDL and LDL fractions (mg/dL), and triglycerides (mg/dL). Considering the entire population, only 9.5% of the individuals had no concomitant comorbidities or renal damage: 8.8% had GFR ≥ 60 mL/min/1.73m2 and 0.7% had GFR < 60 mL/min/1.73m2 as shown in Fig 2. Only 0.7% of the entire studied population had GFR <60 mL/min/1.73m2 without simultaneous diseases or kidney damage. The major risk factors for CKD were obesity or overweight, diabetes, hypertension and dyslipidemia. �x(�U�1Ł�!zZWú;@9�I�Z�2d4p0h4�v0v ��``��L3@Lft�w3J�|e�g>�p�a�z�O�&Lәg��,�����i�HM�BLS iV�L�#%�̓��0 A�$_ Mean GFR was 75.43±0.75 mL/min/1.73m2 (19.6% with GFR ≥ 90, 28.8% with GFR 89–75, 31.8% with GFR 74–60, 14.2% with GFR 59–45, 4.4% with GFR 44–30, 0.8% with GFR 29–15 and only 0.4% with GFR<15 mL/min/1.73m2). In addition to physical care, older people require emotional support. WAMA Diagnóstica Ltda, São Carlos, SP, Brazil). [8], Epidemiological population-based data on CKD prevalence are scarce, particularly in low and middle-lower income countries where the elderly population is increasing, as is the prevalence of diabetes, hypertension and obesity. There were no differences between the individuals with and without blood collection. The decreased GFR group showed lower levels of hemoglobin (13.9±0.1 vs 14.3±0.1 g/dL, p<0.001) and higher levels of urea (52.6±1.2 vs 35.8±0.4 mg/dL, p<0.001), uric acid (6.1±0.1 vs 5.0±0.1 mg/dL, p<0.001) and calcium (4.54±0.01 versus 4.49±0.01 mEq/L, p = 0.003). Decreased GFR was highly prevalent among the geriatric population in a megalopolis of a developing country. In the group of individuals with neither renal damage nor associated comorbidities, a comparison between those with GFR <60 mL/min/1.73 m2 (weighted sample size: 6848) and those with GFR ≥60 mL/min/1.73 m2 (weighted sample size: 88,662) showed that the former individuals were older (58.0% versus 3.9% aged ≥ 80 years, p<0.001), were mainly female (87.5% versus 42.3%, p = 0.004) and Caucasian (95.1% versus 69.7%, p = 0.023). Data from the National Health and Nutrition Examination Survey (NHANES 2007–2012) showed a CKD prevalence of 5.7%, 8.9% and 33.2% in age groups of 20–39, 40–59 and ≥ 60 years, respectively. Among those with GFR< 60 mL/min/1.73m2 the number of individuals who completed the 8-year basic cycle of schooling was reduced (18.2% versus 30.3%, p = 0.01). The presence of proteinuria increases the morbidity and mortality induced by a decreased GFR. Yes This is a cross-sectional study of data from the Saúde, Bem-Estar e Envelhecimento cohort study (SABE study[Health, Well-Being and Aging]), a multiple cohorts study. The sample was selected by multistage cluster sampling, as described elsewhere. GFR was estimated by the simplified Modification of Diet in Renal Disease (MDRD) equation using 4 variables and no standardized SCr: GFR = 186 x (SCr, mg/dL)-1.154 x (age, years)-0.203 x 1.212 (if African-American) x 0.742 (if female). These graphs have a square or “pillar” shape rather than a pyramid one. [20]. However, when only the individuals with GFR <60 mL/min/1.73 m2 were analyzed, 3.6% of them had neither renal damage nor associated comorbidities, whereas among those with GFR ≥60 mL/min/1.73 m2, 10.9% had none of these conditions. The MMSE has thirteen items that are less dependent upon schooling because the South American elderly population as a whole has a low level of schooling. Included in the latest estimates are age, race, and gender data for the United States, states, and counties for 2010 through 2019. 522 0 obj <> endobj
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