Elsevier

Archives of Gerontology and Geriatrics

Volume 57, Issue 3, November–December 2013, Pages 328-332
Archives of Gerontology and Geriatrics

Chronic kidney disease (CKD) is an independent risk factor for long-term care insurance (LTCI) need certification among older Japanese adults: A two-year prospective cohort study

https://doi.org/10.1016/j.archger.2013.03.009Get rights and content

Abstract

CKD is associated with impairments in health status, physical function, and frailty. The aim of the current prospective cohort study was to determine whether CKD predicted new LTCI need certification among community-dwelling older Japanese adults. This was a prospective cohort study. We analyzed the cohort data from a prospective study, The Japan Multicenter Aging Cohort for Care Prevention (J-MACC). We followed 8063 elderly adults for 2 years, and we analyzed the relationship between CKD and LTCI need. The outcome studied was new certification for LTCI service need during a 2-year period. We measured serum creatinine (the estimated glomerular filtration rate; eGFR), serum albumin, frailty checklist scores, and body mass index. During the 2-year follow-up, 536 subjects (6.6%) were newly certified as needing LTCI services. We stratified the cohort according to eGFR quartile and performed multivariate analyses using an eGFR value of 71.4–83.6 ml/min/1.73 m2 as a reference. We found that subjects with eGFR values <60.0 ml/min/1.73 m2 had a significantly elevated risk of LTCI service need (adjusted hazard ratio: 1.44 [95% CI 1.12–1.86]). Our results indicate that CKD is independently associated with new LTCI service need certification and is an important marker of frailty in older adults.

Introduction

Frailty in older adults is a serious problem in countries with aging populations, such as Japan. In general, frailty is defined as a vulnerable state that places older adults at high risk of adverse health outcomes, such as falls, hospitalization, and mortality (Wiswell et al., 2001).

Age is a major risk factor for CKD, which is a growing health problem in Japan. The prevalence of CKD in the adult Japanese population is estimated to be 13% (Imai et al., 2009). In addition, the number of patients with end-stage renal disease (ESRD) has increased by approximately 7% per year in Japan (Akiba et al., 2000). CKD is associated with impairments in health status and physical function, as well as frailty (Brogan et al., 2000, Kurella et al., 2004, Kurella et al., 2005). CKD is also associated with oxidative stress, chronic inflammation, insulin resistance, vascular calcification, and osteoporosis (Ensrud et al., 2007, Landau et al., 2011, Shanahan, 2005). Furthermore, a decreased creatinine clearance <60 ml/min/1.73 m2 has been shown to predict incident falls among community-dwelling older women (Gallagher, Rapuri, & Smith, 2007). Thus, CKD poses a considerable medical and public health challenge, particularly in the older population.

Japan implemented a LTCI system in April 2000 to help manage a rapidly aging population. Prior to 2000, long-term care services were provided under a tax-based social welfare system for seniors with limited economic resources and family support (Campbell & Ikegami, 2000). However, since the implementation of LTCI, the services of this program have been provided to elderly adults who are certified as requiring support or care according to their care needs and certification assessment (Tsutsui & Muramatsu, 2005).

The aim of the current prospective cohort study, therefore, was to determine whether CKD was a risk factor for LTCI need among community-dwelling older Japanese adults.

Section snippets

Subjects

We analyzed the cohort data from a prospective study entitled J-MACC. This cohort study investigated the factors associated with LTCI need in community-dwelling Japanese adults aged 65 years or older. We recruited community-dwelling older adults who were independent in terms of the activities of daily living (ADL) in 2009. The exclusion criteria were older adults who were already ADL-dependent and were eligible to receive benefits from LTCI services. The subjects were followed prospectively for

Results

During the 2-year follow-up, 536 subjects (6.6%) became newly certified as needing LTCI services (Table 2). Those who were certified for LTCI need were significantly older (80.8 ± 7.4 vs. 76.7 ± 6.5, P < 0.001) and had higher frailty checklist scores (6.5 ± 4.9 vs. 4.3 ± 4.0, P < 0.001), lower serum albumin levels (4.2 ± 0.3 vs. 4.3 ± 0.3, P < 0.001), and lower eGFR values (68.5 ± 20.7 vs. 71.4 ± 17.2, P < 0.001) than those who were not certified. More women than men became certified in this cohort (female: 61.6% vs.

Discussion

In this study, we found that approximately 25% of adults aged 65 years or over had eGFR values <60 ml/min/1.73 m2, which indicates that CKD is common among older Japanese adults. The multivariate analyses demonstrated eGFR values <60.0 ml/min/1.73 m2 were independently associated with new certifications for LTCI service need. Thus, our data indicate that CKD is a critical marker of frailty in older adults.

According to the multivariate analyses, lower BMIs (less than 20.5), and higher frailty

Conflicts of interest

None of the authors have conflicts of interest or financial disclosures.

Acknowledgments

The authors acknowledge Ms. Tomoko Kodama and Mr. Seiji Moriguchi for their contributions to the data collection. This study was supported in part by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

References (26)

  • M. Cozzolino et al.

    The impact of paricalcitol on left ventricular hypertrophy

    Contributions to Nephrology

    (2011)
  • K.E. Ensrud et al.

    Renal function and risk of hip and vertebral fractures in older women

    Archives of Internal Medicine

    (2007)
  • J.C. Gallagher et al.

    An age-related decrease in creatinine clearance is associated with an increase in number of falls in untreated women but not in women receiving calcitriol treatment

    Journal of Clinical Endocrinology and Metabolism

    (2007)
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