Original study
Prevalence of Moderate and Severe Renal Insufficiency in Older Persons With Hypertension, Diabetes Mellitus, Coronary Artery Disease, Peripheral Arterial Disease, Ischemic Stroke, or Congestive Heart Failure in an Academic Nursing Home

https://doi.org/10.1016/j.jamda.2008.01.002Get rights and content

Objective

To determine the prevalence of moderate and severe renal insufficiency in older persons in an academic nursing home.

Design

The prevalence of an estimated glomerular filtration rate (GFR) determined by the Modification of Diet in Renal Disease equation less than 60 mL/min/1.73 m2 was investigated in older persons in an academic nursing home with either hypertension, diabetes mellitus, coronary artery disease (CAD), peripheral arterial disease (PAD), ischemic stroke, or congestive heart failure (CHF).

Setting

An academic nursing home.

Participants

Two hundred and two persons (104 women and 98 men), mean age 73 years (range 50 to 98 years) residing in an academic nursing home.

Measurements

Prevalence of a GFR less than 60 mL/min/1.73 m2.

Results

A GFR less than 60 mL/min/1.73 m2 was present in 60 (42%) of 143 persons with hypertension, in 30 (48%) of 62 persons with diabetes mellitus, in 28 (52%) of 52 persons with CAD, in 13 (50%) of 26 persons with PAD, in 10 (44%) of 23 persons with ischemic stroke, and in 15 (63%) of 24 persons with CHF.

Conclusion

Older persons with hypertension, diabetes mellitus, CAD, PAD, ischemic stroke, or CHF have a high prevalence of moderate or severe renal insufficiency and should be treated optimally to reduce the increased risk of cardiovascular events and mortality in this high-risk population.

Section snippets

Methods

The charts of all persons aged 50 years and older during a 3-month period who were not terminally ill in an academic nursing home affiliated with Westchester Medical Center/New York Medical College and staffed by full-time physicians from the Division of Geriatrics of New York Medical College were reviewed by 2 physicians according to a protocol designed by one of the authors (W.S.A.). The study population included 104 women and 98 men, mean age 73 ± 9 years (range 50 to 98 years).

The charts

Results

Of 202 older persons in the nursing home, 143 (71%) had hypertension, 62 (31%) had diabetes mellitus, 54 (27%) had CAD, 26 (13%) had PAD, 23 (11%) had ischemic stroke, and 24 (12%) had CHF. Table 1 shows the prevalence of moderate renal insufficiency, of severe renal insufficiency, and of moderate or severe renal insufficiency in the older persons with hypertension, diabetes mellitus, CAD, PAD, ischemic stroke, or CHF. Table 2 shows the prevalence of moderate or severe renal insufficiency in

Discussion

In the present study of older persons, mean age 73 years, who were not terminally ill in an academic nursing home, the prevalence of hypertension was 71%, of diabetes mellitus was 31%, of CAD was 27%, of PAD was 13%, of CHF was 12%, and of ischemic stroke was 11%. Since persons, especially the elderly, may have an estimated GFR of less than 60 mL/min/1.73 m2 with a normal serum creatinine, the National Kidney Foundation recommends measuring the estimated GFR by using the Modification of Diet in

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    The authors have no conflicts of interest regarding this article.

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    Copyright © 2008 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.