Enfermedad renal crónica en Atención Primaria: prevalencia y factores de riesgo asociados

OBJECTIVE: To determine the prevalence of chronic kidney disease and associated risk factors in subjects over 60 years of age, as well as its staging by determining the glomerular filtration rate (GFR). DESIGN: Cross-sectional observational study. SETTING: Primary Health Care. PARTICIPANTS: Patients ≥ 60 years of age who were seen in 40 Primary Health Care centres with serum creatinine measured in a central laboratory between January 1 and December 31, 2010. Exclusion criteria: kidney transplant, home care. MAIN MEASURES: Social-demographic and anthropometric data, cardiovascular risk factors, and diseases established according to electronic clinical records. Serum creatinine was measured using standardised Jaffe kinetic method, and GFR estimated with MDRD-4-IDMS and CKD-EPI. RESULTS: A total of 97,665 subjects (57.3% women, median age 70.0 years [Q1: 65.0, Q3: 77.0]). GFR-MDRD prevalence < 60 = 15.1% (16.6% in women, 13.2% in men; P < .001) and increased with age. Multivariate analysis showed a positive association between GFR-MDRD < 60 and age (OR = 1.74; 95% CI 1.70 to 1.77), hypertension (OR = 2.18; 95% CI 2.08 to 2.30), heart failure (OR = 2.03; 95% CI 1.83 to 2.25), atrial fibrillation (OR = 1.57; 95% CI 1.41 to 1.76), ischaemic heart disease (OR = 1.40; 95% CI 1.30 to 1.50), peripheral arterial disease (OR = 1.31; 95% CI 1.09 to 1.57), dyslipidaemia (OR = 1.28; 95% CI 1.23 to 1.33), diabetes (OR = 1.26; 95% CI 1.17 to 1.34), and stroke (OR = 1.17; 95% CI 1.09 to 1.25). The GFR-CKD-EPI model showed an increase in OR with age and male sex, that became significant as a chronic kidney disease risk factor. CONCLUSIONS: Chronic kidney disease has considerable prevalence in subjects ≥ 60 years seen in Primary Health Care, more in women, and increasing with age. Hypertension, more than diabetes, was the main associated cardiovascular risk factor.