Chronic Kidney Disease and Functional Limitation in Older People: Health, Aging and Body Composition Study

Authors

  • Linda F. Fried MD, MPH,

    1. From the *Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRenal-Electrolyte Division and Division of Geriatric Medicine, School of Medicine, and §Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaGeneral Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CaliforniaDepartments of Medicine, Epidemiology, and Biostatistics, and #Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco, California**Division of Nephrology, Department of Medicine, University of Tennessee at Memphis, Memphis, Tennessee††Geriatric Division, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and ‡‡National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
    Search for more papers by this author
  • Jung Sun Lee PhD,

    1. From the *Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRenal-Electrolyte Division and Division of Geriatric Medicine, School of Medicine, and §Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaGeneral Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CaliforniaDepartments of Medicine, Epidemiology, and Biostatistics, and #Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco, California**Division of Nephrology, Department of Medicine, University of Tennessee at Memphis, Memphis, Tennessee††Geriatric Division, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and ‡‡National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
    Search for more papers by this author
  • Michael Shlipak MD, MPH,

    1. From the *Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRenal-Electrolyte Division and Division of Geriatric Medicine, School of Medicine, and §Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaGeneral Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CaliforniaDepartments of Medicine, Epidemiology, and Biostatistics, and #Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco, California**Division of Nephrology, Department of Medicine, University of Tennessee at Memphis, Memphis, Tennessee††Geriatric Division, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and ‡‡National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
    Search for more papers by this author
  • Glenn M. Chertow MD, MPH,

    1. From the *Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRenal-Electrolyte Division and Division of Geriatric Medicine, School of Medicine, and §Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaGeneral Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CaliforniaDepartments of Medicine, Epidemiology, and Biostatistics, and #Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco, California**Division of Nephrology, Department of Medicine, University of Tennessee at Memphis, Memphis, Tennessee††Geriatric Division, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and ‡‡National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
    Search for more papers by this author
  • Christie Green MD,

    1. From the *Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRenal-Electrolyte Division and Division of Geriatric Medicine, School of Medicine, and §Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaGeneral Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CaliforniaDepartments of Medicine, Epidemiology, and Biostatistics, and #Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco, California**Division of Nephrology, Department of Medicine, University of Tennessee at Memphis, Memphis, Tennessee††Geriatric Division, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and ‡‡National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
    Search for more papers by this author
  • Jingzhong Ding PhD,

    1. From the *Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRenal-Electrolyte Division and Division of Geriatric Medicine, School of Medicine, and §Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaGeneral Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CaliforniaDepartments of Medicine, Epidemiology, and Biostatistics, and #Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco, California**Division of Nephrology, Department of Medicine, University of Tennessee at Memphis, Memphis, Tennessee††Geriatric Division, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and ‡‡National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
    Search for more papers by this author
  • Tamara Harris MD, MS,

    1. From the *Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRenal-Electrolyte Division and Division of Geriatric Medicine, School of Medicine, and §Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaGeneral Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CaliforniaDepartments of Medicine, Epidemiology, and Biostatistics, and #Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco, California**Division of Nephrology, Department of Medicine, University of Tennessee at Memphis, Memphis, Tennessee††Geriatric Division, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and ‡‡National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
    Search for more papers by this author
  • Anne B. Newman MD, MPH,

    1. From the *Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRenal-Electrolyte Division and Division of Geriatric Medicine, School of Medicine, and §Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaGeneral Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CaliforniaDepartments of Medicine, Epidemiology, and Biostatistics, and #Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco, California**Division of Nephrology, Department of Medicine, University of Tennessee at Memphis, Memphis, Tennessee††Geriatric Division, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and ‡‡National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
    Search for more papers by this author
  • for the Health, Aging and Body Composition Study

    1. From the *Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRenal-Electrolyte Division and Division of Geriatric Medicine, School of Medicine, and §Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PennsylvaniaGeneral Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CaliforniaDepartments of Medicine, Epidemiology, and Biostatistics, and #Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco, California**Division of Nephrology, Department of Medicine, University of Tennessee at Memphis, Memphis, Tennessee††Geriatric Division, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and ‡‡National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
    Search for more papers by this author

  • This work was presented at the November 2004 American Society of Nephrology Meeting.

Address correspondence to Linda Fried, MD, MPH, VA Pittsburgh Healthcare System, University Drive, Mailstop 111F-U, Pittsburgh, PA 15240. E-mail: Linda.Fried@med.va.gov

Abstract

OBJECTIVES: To assess whether chronic kidney disease (CKD) is independently associated with incident physical-function limitation.

DESIGN: Prospective cohort study.

SETTING: Two sites: Pittsburgh, Pennsylvania, and Memphis, Tennessee.

PARTICIPANTS: Two thousand one hundred thirty-five men and women aged 70 to 79 without functional limitation at baseline from the Health, Aging and Body Composition Study.

MEASUREMENTS: Functional limitation was defined as difficulty in walking one-quarter of a mile or climbing 10 steps on two consecutive reports 6 months apart (in the same function). Kidney function was measured using serum cystatin C. Estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease formula (<60 versus ≥60 mL/min per 1.73 m2), was a secondary predictor. Muscle strength, lean body mass according to dual energy x-ray absorptiometry, comorbidity, medication use, and inflammatory markers were evaluated as covariates.

RESULTS: Persons in the highest (≥1.13 mg/L) quartile of cystatin C experienced a significantly higher risk of developing functional limitation than those in the lowest (<0.86 mg/L) quartile (hazard ratio (HR)=1.70, 95% confidence interval (CI)=1.40–2.07). The association between the fourth cystatin C quartile and functional limitation remained after adjustment for demographics, lean body mass, comorbidity, muscle strength, and gait speed (HR=1.41, 95% CI=1.13–1.75), although the association was attenuated after adjustment for markers of inflammation (HR=1.15, 95% CI=0.90–1.46). Similar results were found for eGFR less than 60 mL/min per 1.73 m2, although the association with functional limitation remained after adjustment for inflammatory markers (HR=1.30, 95% CI=1.08–1.56).

CONCLUSION: CKD is associated with the development of functional impairment independent of comorbidity, body composition, and tests of strength and physical performance. The mechanism may be related to a heightened inflammatory state in CKD.

Ancillary