Chronic Renal Failure: A Neglected Comorbidity of COPD

doi:10.1378/chest.09-1710

Chest

Volume 137, Issue 4, April 2010, Pages 831-837

https://doi.org/10.1378/chest.09-1710 Get rights and content

Background

To the best of our knowledge, the association between COPD and chronic renal failure (CRF) has never been assessed. Lean mass is frequently reduced in COPD, and the glomerular filtration rate (GFR) might be depressed in spite of normal serum creatinine (concealed CRF). We investigated the prevalence and correlates of both concealed and overt CRF in elderly patients with COPD.

Methods

We evaluated 356 consecutive elderly outpatients with COPD enrolled in the Extrapulmonary Consequences of COPD in the Elderly Study and 290 age-matched outpatients free from COPD. The GFR was estimated using the Modification of Diet in Renal Disease Study Group equation. Patients were categorized as having normal renal function (GFR ≥ 60 mL/min/1.73 m²), concealed CRF (normal serum creatinine and reduced GFR), or overt CRF (increased serum creatinine and reduced GFR). Independent correlates of CRF were investigated by logistic regression analysis.

Results

The prevalence of concealed and overt CRF in patients with COPD was 20.8% and 22.2%, respectively. Corresponding figures in controls were 10.0% and 13.4%, respectively. COPD and age were significantly associated with both concealed CRF (COPD: odds ratio [OR] = 2.19, 95% CI = 1.17-4.12; age: OR = 1.06, 95% CI = 1.04-1.09) and overt CRF (COPD: OR = 1.94, 95% CI = 1.01-4.66; age: OR = 1.06, 95% CI = 1.04-1.10). Diabetes (OR = 1.96, 95% CI = 1.02-3.76), hypoalbuminemia (OR = 2.83, 95% CI = 1.70-4.73), and muscle-skeletal diseases (OR = 1.78, 95% CI = 1.01-3.16) were significant correlates of concealed CRF. BMI (OR = 1.05, 95% CI = 1.01-1.10) and diabetes (OR = 2.25, 95% CI = 1.26-4.03) were significantly associated with overt CRF.

Conclusions

CRF is highly prevalent in patients with COPD, even with normal serum creatinine, and might contribute to explaining selected conditions such as anemia that are frequent complications of COPD.

Section snippets

Design Overview

We used data coming from the Extrapulmonary Consequences of COPD in the Elderly study, a population-based observational study of white patients with COPD aged 65 years and older aimed at exploring extrapulmonary consequences of COPD. The diagnosis of COPD conformed to American Thoracic Society/European Respiratory Society guidelines.²¹ To be included in the study, patients had to be in a stable condition and with no physical findings or symptoms suggestive of acute exacerbation or therapy

Results

The mean age of enrolled patients was 75.4 years (SD 6.1, range 61-92), 19.7% of them were women. The mean serum creatinine concentration was 1.06 mg/dL (SD 0.40), and the mean estimated GFR was 64.2 mL/min/1.73 m² (SD 19.2). The control group had a similar mean age (73.9 years, SD 7.9, range 59-89), and 21.0% of them were women. The mean serum creatinine in the control group was 1.05 (SD 0.55), and the mean estimated GFR was 75.4 mL/min/1.73 m² (SD 22.4). The most common main diseases in the

Discussion

This study shows that CRF is highly prevalent in an elderly population with COPD and associates with selected nonrespiratory comorbidities. While serum creatinine greater than 1.26 mg/dL for men and 1.04 mg/mL for women³⁰ is a reliable marker of CRF, the GFR is frequently depressed despite normal serum creatinine, mainly in women and older patients.

The estimated prevalence of CRF in the population with COPD was greater than that observed in the control population with a comparable burden of

Acknowledgments

Author contributions: Dr Antonelli Incalzi: participated in the study design, data analysis and interpretation, and manuscript preparation.

Dr Corsonello: participated in data collection, data analysis, and manuscript preparation, and can vouch for the data.

Dr Pedone: participated in data collection, data analysis, and manuscript preparation.

Dr Battaglia: participated in data collection, data analysis, and manuscript preparation, and can vouch for the data.

Dr Paglino: participated in data

References (0)

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^*: A complete list of study participants is located in the Appendix.

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Chest

Original ResearchCOPDChronic Renal Failure: A Neglected Comorbidity of COPD

Background

Methods

Results

Conclusions

Section snippets

Design Overview

Results

Discussion

Acknowledgments

Original Research
COPD
Chronic Renal Failure: A Neglected Comorbidity of COPD