Chronic Kidney Disease, Life-space Restriction, and Mortality in the UAB Study of Aging Público

Abstract

Background: Chronic kidney disease (CKD) prognosis relies on estimated glomerular filtration rate (eGFR). The life-space mobility assessment is a novel measure that quantifies the distance, frequency, and independence achieved as older adults move through their environment. Although life-space restriction (LSR) has been shown to be associated with mortality, its prognostic significance has yet to be examined in older adults with CKD.

Methods: Using a subset (n=400) of the University of Alabama-Birmingham Study of Aging, we investigated the joint effects of CKD, defined by eGFR<60 ml/min/1.73m², and LSR, defined as composite life-space score<60, on all-cause mortality using Cox proportional hazards regression adjusting for sociodemographics and medical comorbidities.

Results: Overall, 50% of participants had CKD and 45% had LSR. Mortality rates (per 1,000 person-years) were 31.3, 38.6, 87.4, and 80.0 among those with No CKD/No LSR, CKD/No LSR, No CKD/LSR, and CKD/LSR. Compared to participants with neither exposure (No CKD/No LSR), hazard ratios (HR; 95% confidence intervals) for mortality were 1.07 (0.52-2.19), 2.11 (1.06-4.17), and 1.94 (0.97-3.90) for the CKD/No LSR, No CKD/LSR, and CKD/LSR groups. Using a CKD cut-point of eGFR<45 ml/min/1.73m², multivariable adjusted HRs were 1.51 (0.63-3.60), 1.86 (1.03-3.35) and 3.26 (1.64-6.50) for the eGFR<45/No LSR, eGFR≥45/LSR, and eGFR<45/LSR groups, respectively. After stratification of the sample by CKD status, HRs for the association between LSR and mortality, adjusted as above, were 1.79 (0.89-3.64) in those with CKD and 2.48 (1.13-5.43) in those without CKD.

Conclusions: Restricted life-space is associated with increased mortality risk and may provide additional prognostic information to guide CKD management beyond that offered by eGFR.

Table of Contents

Table of Contents

• Introduction (p.2)
• Methods (p.4)
  
• Results (p.9)
  
• Discussion (p.12)
  
• References (p.16)
  
• Tables
  
  • Table 1. Baseline participant characteristics (n=400) from the UAB Study of Aging by categories of chronic kidney disease and life-space restriction exposure (p.18)
    
  • Table 2. Deaths and mortality rate in the UAB Study of Aging by chronic kidney disease (CKD) and life-space restriction (LSR) (n=400) (p.19)
    
  • Table 3. Multi-variable hazard regression models presenting hazard ratios (HR) for the risk of all-cause mortality for those with life-space restriction in all study participants, in those with chronic kidney disease (CKD) and in those without CKD from the UAB Study of Aging (n=400) (p.20)
    
  • Table 4. Adjusted hazard ratios for risk of all-cause mortality from the joint exposure of chronic kidney disease (CKD) and life-space restriction (LSR) in the UAB Study of Aging (p.21)
    
  • Table 5. Deaths, mortality rates, and adjusted hazard ratios (HR) for risk of mortality under the secondary eGFR analysis conditions in the UAB Study of Aging by eGFR and life-space restriction (LSR) (n=400) (p.22)
• Figures
  
  • Figure 1. Cumulative mortality curves for dual exposure categories of chronic kidney disease (CKD) and life-space restriction (LSR) in the UAB Study of Aging (p.23)
    
  • Figure 2. Cumulative mortality curves for dual exposure categories of reduced eGFR and life-space restriction (LSR) in the UAB Study of Aging (p.24)
    
• Appendix
  
  • Appendix 1. Sample Life-Space Assessment for a theoretical participant near the cut-point for life-space restriction (p.25)

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Aging Gerontology Health Sciences, Medicine and Surgery
Palavra-chave	mobility chronic kidney disease life-space
Committee Chair / Thesis Advisor	Johnson II, Theodore M, Emory University Bowling, Barrett, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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