Chronic Kidney Disease and Metabolic Disorders in the Elderly

Overview

The goal of this observational study is to investigate the impact of metabolic comorbidities on outcomes in elderly Chinese adults, through two parallel sub-cohorts: one comprising elderly individuals without chronic kidney disease (CKD) at baseline, and one comprising elderly patients with established CKD. The main questions it aims to answer are: Do metabolic diseases (diabetes, hypertension, hyperlipidemia, hyperuricemia, calcium-phosphorus disorders) increase the risk of incident CKD, major adverse cardiovascular events (MACE), and all-cause mortality in elderly individuals without CKD at baseline? What are the optimal diagnostic thresholds and criteria for CKD in the elderly population? How do metabolic comorbidities affect long-term outcomes - including all-cause mortality, end-stage renal disease (ESRD), and cardiovascular events - in elderly patients with established CKD? What is the comorbidity profile and disease burden of elderly CKD patients in China? Participants in both sub-cohorts will: Undergo baseline assessments including laboratory tests and clinical evaluations. Provide longitudinal follow-up data through scheduled clinic visits and medical record linkage. Contribute to a large-scale cohort of 100,000 elderly participants across multiple centers in China.

Background and Rationale Chronic kidney disease (CKD) complicated by metabolic disorders - including diabetes mellitus, hypertension, hyperlipidemia, hyperuricemia, and calcium-phosphorus disturbances - poses a significant public health threat to the elderly population. China is experiencing accelerating demographic aging, making the burden of CKD and metabolic comorbidity in older adults an increasingly pressing clinical and policy challenge. Current clinical practice is often characterized by a fragmented approach in which multiple coexisting conditions are managed independently, without an integrated framework that accounts for their interactions. Furthermore, there is no international consensus on the diagnostic criteria, epidemiological characteristics, or prognostic assessment of CKD in the elderly. Study Design This is a multicenter, prospective and retrospective observational cohort study aiming to enroll a total of 100,000 elderly participants. The study comprises two sub-cohorts with distinct eligibility criteria and complementary scientific objectives: Sub-cohort 1 - Incident CKD in Elderly Adults without CKD at Baseline: Elderly individuals without CKD at baseline will be enrolled and followed longitudinally. Baseline and follow-up data will be collected to evaluate the impact of metabolic diseases (diabetes, hypertension, hyperlipidemia, hyperuricemia, calcium-phosphorus disorders) on the risk of incident CKD, major adverse cardiovascular events (MACE), and all-cause mortality. This sub-cohort will also be used to establish and validate age-appropriate diagnostic thresholds and criteria for CKD in the elderly Chinese population. Sub-cohort 2 - Elderly CKD Patients with Metabolic Comorbidities: Elderly patients with established CKD (stages 1-4, excluding stage 5 or those already on renal replacement therapy) will be enrolled. Baseline and longitudinal follow-up data will be used to characterize the comorbidity profile of elderly CKD patients in China, and to evaluate the effects of metabolic comorbidities on long-term outcomes, including all-cause mortality, progression to end-stage renal disease (ESRD), and cardiovascular events. The objectives of this study are: To describe the epidemiological characteristics and risk factor profiles of CKD-metabolic comorbidity in elderly adults in China. To establish and validate age-appropriate diagnostic criteria and thresholds for CKD in the elderly. To evaluate the prognostic impact of metabolic comorbidities on CKD-related outcomes. To develop clinical decision-support tools applicable to community and home-based settings. To provide evidence to inform the development and updating of relevant clinical guidelines.