AGNES - Aging nephropathy study: a prospective observational cohort of chronic kidney disease in elderly patients

• Grant number: 19/04045-5
• Support Opportunities: Regular Research Grants
• Start date: July 01, 2020
• End date: June 30, 2023
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Rosilene Motta Elias Coelho
• Grantee: Rosilene Motta Elias Coelho
• Host Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• City of the host institution: São Paulo
• Associated researchers: Bengt Lindholm ; Carla Maria Avesani ; Peter Stenvinkel ; Rosa Maria Affonso Moysés ; Venceslau Antonio Coelho

Abstract

With increase of longevity, the high prevalence of obesity, systemic arterial hypertension and diabetes mellitus, we are facing an increased incidence of elderly patients with chronic kidney disease (CKD) initiating renal replacement therapy. Many doubts remain, however, regarding the correct diagnosis of CKD, the prognosis of the elderly patient with CKD, regarding cardiovascular outcomes, mineral and bone mineral metabolism, sarcopenia, geriatric syndromes and sleep disorders. The decision between starting dialysis and conservative management is still controversial. Elderly patients are almost always excluded from the studies and the scientific evidence is sparse or based on retrospective data. In this way, the present study proposes a prospective cohort to evaluate the long-term evolution of patients with 70 years of CKD stage 4 or 5 not on dialysis. Mortality and renal replacement therapy are the main outcomes. These endpoints will be correlated with: geriatric syndromes, markers of mineral and bone metabolism (calcium, phosphorus, vitamin D, Klotho, parathormone, FGF-23, FGF-21, vitamin D and vitamin D 1,25, cognitive decline, clinical data, demographic and biochemical data, bone densitometry and echocardiography, and sleep data.Patients will be followed at the nephrology outpatient clinic of the Hospital das Clínicas of the Medical School of the University of São Paulo. The sample was initially calculated to be 197 subjects and the expected timetable is until the end of 2024. The summary methodology will include: broad geriatric assessment, cognition test, fragility, Charlson comorbidity scores, laboratory measurements of urea, creatinine, estimated glomerular filtration estimated by CKD-EPI, alkaline phosphatase, PTH, total calcium, ionized calcium, phosphorus, 25-vitamin D, complete blood count, vitamin B12, folic acid, TSH, T4L, serum VDRL, hepatitis B and C, HIV virus, serum albumin, albumin/creatinine ratio, protein/creatinine ratio, proteinuria in the 24h urine, skull tomography, bone densitometry, ambulatory blood pressure monitoring (ABPM), actigraphy, polysomnography, Epworth sleepiness scale, Pitssburgh questionnaire and segmental electric bioimpedance. (AU)