Higher albumin:creatinine ratio and lower estimated glomerular filtration rate are potential risk factors for decline of physical performance in the elderly: the Cardiovascular Health Study

• Type of Material: Article
• Authors: Petra Buzkova, University of Washington; Joshua Barzilay, Emory University; Howard A. Fink, VA Health Care System; John A. Robbins, University of California Davis; Jane A. Cauley, University of Pittsburgh; Joachim H. Ix, University of California San Diego; Kenneth J. Mukamal, Harvard University
• Language: English
• Date: 2019-12-01
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s). Published by Oxford University Press on behalf of ERA-EDTA.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ckj/sfz024
• Title of Journal or Parent Work: Clinical Kidney Journal
• Volume: 12
• Issue: 6
• Start Page: 788
• End Page: 794
• Grant/Funding Information: This research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086 and grant U01HL080295 from the National Heart, Lung and Blood Institute (NHLBI), with additional contributions from the National Institute of Neurological Disorders and Stroke.; Additional support was provided by the National Institute on Aging (R01AG023629).
• Keywords: physical performance; Science & Technology; Life Sciences & Biomedicine; CHRONIC KIDNEY-DISEASE; ASSOCIATION; Urology & Nephrology; CYSTATIN-C; HIP FRACTURE RISK; FRAILTY; ALBUMINURIA; albuminuria; RENAL-INSUFFICIENCY; OLDER-ADULTS; appendicular muscle mass; grip strength; gait speed; CREATININE CLEARANCE; CARBOXYMETHYL-LYSINE
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Introduction: Mildly reduced renal function and elevated urine protein levels are each prospectively associated with hip fracture risk in older adults. Here we determine whether these markers are associated with reduced appendicular muscle performance. Methods: We prospectively examined the associations of urine albumin:creatinine ratio (ACR) and reduced estimated glomerular filtration rate (eGFR) with longitudinal changes in grip strength and gait speed >2 years in 2317 older community-dwelling men and women (median age 77 years). The median ACR was 9.8 [interquartile range (IQR) 5.40-21.50] mg/g creatinine and the median eGFR was 71.6 (IQR 59.1-83.56) mL/min/1.73 m2. Models were adjusted for demographic factors, clinical history and biochemical measures in four candidate pathways: Diabetes, oxidative stress, inflammation and fibrosis. Results: In demographic- A nd covariate-adjusted models, a 2-fold higher baseline urine ACR was associated with longitudinal changes of-0.17 kg [95% confidence interval (CI)-0.29 to-0.06) in grip strength and-1.10 cm/s (95% CI-1.67 to-0.53) gait speed per year. Corresponding estimates for a 10 mL/min/1.73 m2 lower baseline eGFR were-0.13 kg (95% CI-0.23 to-0.04) and-0.89 cm/s (95% CI-1.37 to-0.40), respectively. The associations of a 2-fold higher baseline ACR and a 10 mL/min/1.73 m2 lower baseline eGFR using cystatin C with grip strength and gait speed were equivalent to ∼1.2-1.9 additional years of age. Adjustment for covariates in candidate pathways did not attenuate these estimates. Conclusions: In older adults, higher ACR and lower eGFR are potential risk factors for a decline of physical performance >2 years.