Chronic Kidney Disease (CKD) is a progressive and irreversible condition characterized by a gradual decline in kidney function over time. (1) It is a major global health concern, affecting millions of individuals worldwide. CKD is defined by a persistent reduction in glomerular filtration rate (GFR) below 60 mL/min/1.73m² for more than three months, often accompanied by structural or functional abnormalities of the kidney. (2) The disease is classified into five stages, ranging from mild kidney impairment to end-stage renal disease (ESRD), which requires dialysis or kidney transplantation for survival. (3)

Epidemiology and Risk Factors

The prevalence of CKD has been steadily increasing, primarily due to the rising incidence of diabetes mellitus and hypertension, which are the leading causes of kidney damage. Other contributing factors include genetic predisposition, obesity, smoking, aging, and exposure to nephrotoxic drugs. Studies indicate that CKD disproportionately affects older adults, with individuals above 60 years being at the highest risk of developing advanced renal dysfunction. Additionally, socioeconomic factors play a crucial role, as limited access to healthcare and delayed diagnosis contribute to disease progression. (4)

Pathophysiology and Clinical Manifestations

CKD results from chronic damage to the nephrons, leading to impaired filtration, electrolyte imbalances, and accumulation of metabolic waste products in the bloodstream. The disease progresses through various pathophysiological mechanisms, including glomerular hypertension, inflammation, oxidative stress, and fibrosis. Patients with CKD often present with nonspecific symptoms in the early stages, such as fatigue, nausea, and muscle weakness. As the disease advances, complications such as anemia, metabolic acidosis, cardiovascular disorders, and fluid retention become more pronounced. (5)

Importance of Early Detection and Management

Early detection of CKD is critical in preventing progression to ESRD. Routine screening, especially for high-risk populations, can help identify early-stage CKD and allow for timely intervention. Management strategies include lifestyle modifications, blood pressure control, glycemic regulation, and dietary adjustments to slow disease progression. Additionally, emerging research highlights the potential of novel biomarkers and precision medicine in improving CKD diagnosis and treatment outcomes. (6)

This This study was conducted at Rajshree Medical Research Institute, Bareilly, using a cross-sectional observational design to analyze the correlation between age and presenting symptoms in 218 CKD patients. The methodology was structured as follows:

Study Design and Population

A hospital-based cross-sectional study was performed over a 12-month period.

Patients diagnosed with CKD (Stages 1-5) based on eGFR criteria (<60 mL/min/1.73m² for >3 months) were included.

Exclusion criteria: Patients with acute kidney injury (AKI), end-stage renal disease (ESRD) on dialysis, and those with secondary renal diseases (e.g., lupus nephritis).

Data Collection

Demographic details like age were recorded.

Clinical symptoms were documented using a structured questionnaire.

Laboratory investigations included:

• Serum creatinine and eGFR (estimated using the CKD-EPI formula).
• Electrolyte levels (sodium, potassium, calcium).
• Hemoglobin levels (to assess anemia prevalence).
• Blood pressure measurements (to evaluate hypertension).
• Urine albumin-to-creatinine ratio (for proteinuria assessment).

Statistical Analysis

Descriptive statistics were used to summarize patient characteristics.

Chi-square tests were applied to assess the correlation between age and symptom presentation.

Multivariate regression analysis was conducted to identify independent predictors of CKD severity.

p-values <0.05 were considered statistically significant.

ETHICAL CONSIDERATIONS AND CONFIDENTIALITY:

Ethical approval for this study was provided by the Institutional Ethical Committee, and informed consent was obtained from each of the study participants. Participants were allowed to withdraw their names at any given time during the course of the study. Confidentiality of all the data was ensured by keeping the responses anonymous.

The study analyzed 218 CKD patients across five age groups, revealing distinct symptom patterns. The mean age was 52.8 years, with a male predominance (67%). The correlation between age and symptom presentation was statistically significant (p < 0.001).

≤30 years: Younger patients predominantly reported nausea/vomiting (59.6%), muscle weakness (31.7%), and fatigue (27.4%). These symptoms were often linked to early-stage CKD, where metabolic waste accumulation begins affecting systemic functions.

31-40 years: Gastrointestinal symptoms remained prevalent, but metabolic imbalances such as hyperkalemia (22.1%) and hypocalcemia (18.3%) started emerging.

41-50 years: Increased incidence of dyspnea (39.9%), body aches (32.1%), and hypertension (45.6%) was observed. Patients in this group were more likely to be diagnosed with Stage 3 CKD, indicating moderate renal impairment.

51-60 years: Electrolyte disturbances, anemia (41.2%), and fluid retention (36.8%) were more common. Many patients in this group exhibited reduced eGFR (<45 mL/min/1.73m²), suggesting progression to Stage 4 CKD.

>60 years: Older patients presented with advanced complications, including cardiovascular disorders (56.3%), metabolic acidosis (48.7%), and severe renal dysfunction (Stage 5 CKD, 32.9%). The prevalence of diabetes mellitus (62.4%) and hypertension (71.5%) was significantly higher in this group.

These findings align with existing literature, which suggests that CKD progression is age-dependent, with older patients experiencing more severe complications.

Table 1: CKD Stages Among Participants

Table 2: Common Comorbidities Among Participants

Chart 1: Age Group Distribution

Chart 2: Symptoms Among CKD Patients

The results highlight a clear correlation between age and CKD symptomatology, reinforcing the need for age-specific screening and management strategies. Younger patients often present with non-specific symptoms, leading to delayed diagnosis. In contrast, older patients exhibit severe systemic complications, necessitating aggressive intervention.

Clinical Implications

Early Detection in Younger Patients: Since younger individuals primarily report nausea, vomiting, and fatigue, routine metabolic screening could aid in early CKD identification.

Electrolyte Management in Middle-Aged Patients: The emergence of hyperkalemia and hypocalcemia in the 31-50 age group suggests the need for regular electrolyte monitoring.

Cardiovascular Risk in Older Patients: Given the high prevalence of cardiovascular complications in patients >60 years, integrating cardiac assessments into CKD management is crucial.

Comparison with Existing Studies

Previous research has established that CKD progression accelerates with age, leading to higher morbidity and mortality rates. Studies indicate that older patients with CKD are at increased risk of cardiovascular events, supporting our findings. Additionally, the association between diabetes and CKD severity has been well-documented. (6), (7)

This study highlights the age-dependent progression of CKD, emphasizing the need for targeted interventions across different age groups. The findings suggest:

Early Detection in Younger Patients: Since younger individuals primarily report nausea, vomiting, and fatigue, routine metabolic screening could aid in early CKD identification.

Electrolyte Management in Middle-Aged Patients: The emergence of hyperkalemia and hypocalcemia in the 31-50 age group suggests the need for regular electrolyte monitoring.

Cardiovascular Risk in Older Patients: Given the high prevalence of cardiovascular complications in patients >60 years, integrating cardiac assessments into CKD management is crucial.

Future Directions

Longitudinal studies are needed to assess CKD progression over time.

Genetic and environmental factors influencing age-related CKD severity should be explored.

The role of novel biomarkers in predicting CKD progression warrants further investigation.

FINANCIAL SUPPORT AND SPONSORSHIP: Nil

CONFLICTS OF INTEREST: There are no conflicts of interest.

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