Corsonello et al.

BMC Geriatrics 2020, 20(Suppl 1):316

https://doi.org/10.1186/s12877-020-01701-w

INTRODUCTION Open Access

The screening for chronic kidney disease

among older people across Europe (SCOPE)
project: findings from cross-sectional
analysis
Andrea Corsonello1*, Ellen Freiberger2 and Fabrizia Lattanzio1

Editorial community must act sooner and enlist patients’ help in

The scenario of CKD in the older population is known minimizing the comorbidities and progression that too
to be very complex. Among community dwelling older often remain undetected until very late in the disease
people there is a broad range of different functional process” [2].
levels ranging from fitness and robustness to frailty or CKD impact on global health, either as a risk factor for
disability. Impaired physical function, frailty and disabil- morbidity and mortality or by causing cardiovascular dis-
ity, cognitive impairment, depression, vision and hearing ease. A recent systematic analysis of the Global Burden of
impairment, malnutrition, and sarcopenia all contribute Disease Study 1990–2017 [3] showed that over the past 27
to worsen health outcomes and to increase the use of years CKD burden has not declined to the same extent as
health care resources, thus challenging health care sys- many other important non-communicable diseases. How-
tems. The benefits of preventing/slowing the progression ever, CKD and its consequences remain largely preventable
of CKD among these patients have the potential to im- and treatable and deserves greater attention in global health
pact different social and health domains, e.g. reducing policy decision making. Indeed, several studies suggest that
the need for long-term care and the cost related to care- screening for CKD in high-risk and older populations may
giving. Thus, early identification of CKD represents a represent a cost-effective approach to reduce progression
relevant issue to be addressed in the older population. to renal failure and CKD mortality [4–7].
At the end of 2013 the American College of Physicians Current screening measures rely on creatinine-based
(ACP) issued a statement against the usefulness of estimated glomerular filtration rate (eGFR). They are
chronic kidney disease (CKD) screening for the general known to have some degree of inaccuracy when used in
adult population [1]. Those recommendations were se- older people and to carry an increased risk of both over-
verely criticized by nephrologists, fully aware that early and under-diagnosis, but alternative filtration markers
detection and intervention can slow the progression of have been identified and are worth of testing. Indeed, a
CKD to renal failure. Noting the lack of involvement of screening program should take into account the charac-
nephrologists in the development of ACP statements, teristics of the target population to achieve effective re-
Molitoris claimed that “We should be committed to sup- sults. A high proportion of older CKD patients are
porting all approaches that will change kidney disease usually affected by multimorbidity, polypharmacy, frailty,
from a silent disease too often discovered in its late stages functional and cognitive impairment and disability [8–
to one that is identified when modifications can affect the 16]. However, CKD screening programs to date have not
progression of the disease [ … ]. The entire medical included the use of the comprehensive geriatric assess-
ment (CGA), the only assessment technology able to
* Correspondence: [email protected] capture the numerous dimensions of health status and
1
Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo
and Cosenza, Cosenza, Italy their complex interactions in older people. Accordingly,
Full list of author information is available at the end of the article comparing different CKD screening methods for older
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Corsonello et al. BMC Geriatrics 2020, 20(Suppl 1):316 Page 2 of 4

complex patients in regards to their accuracy is consid- increased among patients with estimated glomerular fil-
ered a very important issue to be addressed. Indeed, this tration rate (eGFR) < 30 as compared to those with
view is widely shared by the geriatric and nephrologist eGFR> 60 ml/min/1.73 m2.
communities [17, 18], and the implementation of in- Corsonello et al. showed that CKD contributes significantly
novative findings is expected to improve CKD screening to multimorbidity patterns in a population of older outpa-
and management in such a vulnerable population tients and it was rarely observed without any co-occuring
(Fig. 1). disease. The most significant co-occuring pairs involving
All these aspects have been the primary motivator for CKD included hypertension, anemia, CHF, atrial fibrillation,
the development of a EU funded research project, titled myocardial infarction, hip fracture, and to a lesser extent
“Screening for CKD among Older People across Europe hearing impairment, diabetes and cancer. Cluster analysis
(SCOPE)”, aiming at comparing different screening showed that CKD may cluster with hypertension and sen-
methods for CKD in the older population, including a sory impairments. CKD severity and physical performance as
comprehensive set of CGA variables to explore assessed by the Short Physical Performance Battery (SPPB)
population-specific outcomes [19]. test may be associated with not negligible changes in both
Initial results from the baseline database of the SCOPE co-occuring pairs and multimorbidity clusters. These find-
project [19] have been made available for the participat- ings strengthen the need of including disease severity in mul-
ing researchers in this special issue as a first description timorbidity studies. Additionally, assessing physical function
of the population studied, a cohort of 2464 patients from and investigating interventions targeting physical function
7 countries, through a series of cross-sectional analyses among complex multimorbid patients represents a research
about typically geriatric topics. priority to improve outcomes and reduce costs associated
The main finding from the study by Moreno-Gonzalez with multimorbidity.
et al. is the relevant prevalence of sarcopenia observed Britting et al. showed that CKD, at least in the early
among community-dwelling people aged 75 years and stages, is not a predictor of falls and injurious falls,
older, using the most recent diagnostic criteria for sarco- whereas urinary incontinence measured by lower urinary
penia endorsed by the EWGSOP2 consensus. Partici- tract symptoms (LUTS) increases the risk of falls and in-
pants within poorer eGFR categories, irrespective of the jurious falls. Nevertheless, the development of prospect-
equation used for its calculation, and albuminuria have a ive analysis within the SCOPE study will help to clarify
higher prevalence of sarcopenia and are more often se- the association between CKD and falls. Additionally,
verely sarcopenic. However, there are some differences these findings suggest that treating LUTS and physical
in prevalence according to the eGFR formula used. limitation in older CKD patients might be an appropri-
In the paper by Guligowska et al., the SCOPE study ate way to reduce risk of falling.
population shows generally features of overweight and In the paper by Tap et al. cognitive impairment and
obesity with small prevalence of malnutrition. Higher depressive symptoms were not more prevalent among
weight, circumferences, body mass index (BMI) and community-dwelling older persons in more advanced
waist-to-height ratio (WHtR) were significantly associ- stages of CKD than in those without or in earlier stages
ated with increased likelihood of having CKD, whilst of CKD. Kidney function was comparable in those with
higher Mini Nutritional Assessment (MNA) score and and without any signs of cognitive or mood disorders.
higher serum albumin were inversely associated with The identification of CKD as modifiable risk factor for
CKD. The risk of MNA < 24 or hypoalbuminemia was cognitive impairment and depressive symptoms in late

Fig. 1 Pathways from comprehensive screening to improvement of CKD management among older people
Corsonello et al. BMC Geriatrics 2020, 20(Suppl 1):316 Page 3 of 4

life might be relevant in order to optimize therapeutic ● Department of Medical Sciences, Uppsala University, Sweden: Johan
strategies. Even in this case, longitudinal studies might Ärnlöv, Axel Carlsson, Tobias Feldreich.
We thank the BioGer IRCCS INRCA Biobank for the collection of the SCOPE
give additional information on the possible effect of kid- samples.
ney function and/or CKD progression on mental health Scientific advisory board (SAB).
in late life. Roberto Bernabei, Catholic University of Sacred Heart, Rome, Italy.
Christophe Bula, University of Lausanne, Switzerland.
Artzi-Medvedik et al. showed that CKD and its sever- Hermann Haller, Hannover Medical School, Hannover, Germany.
ity may be significantly associated with impaired Quality Carmine Zoccali, CNR-IBIM Clinical Epidemiology and Pathophysiology of
of Life (QoL) among community-dwelling older people, Renal Diseases and Hypertension, Reggio Calabria, Italy.
Data and Ethics Management Board (DEMB).
even after adjusting for several confounders. Addition- Dr. Kitty Jager, University of Amsterdam, The Netherlands.
ally, physical performance and comorbidities were found Dr. Wim Van Biesen, University Hospital of Ghent, Belgium.
to affect the association between CKD and QoL, which Paul E. Stevens, East Kent Hospitals University NHS Foundation Trust,
Canterbury, United Kingdom.
suggest that efforts should be made to decrease the ef-
fects of such modifiable risk factors in an attempt to im- About this supplement
prove QoL of CKD patients. This article has been published as part of BMC Geriatrics Volume 20
Taken together, the above studies prompt the assess- Supplement 1 2020: The Screening for Chronic Kidney Disease among Older
People across Europe (SCOPE) project: findings from cross-sectional analysis.
ment of nutritional status, sarcopenia, falls, mental The full contents of the supplement are available at https://bmcgeriatr.bio-
health, quality of life, multimorbidity and physical func- medcentral.com/articles/supplements/volume-20-supplement-1
tion, and may be warranted in the usual care of older
people with impaired kidney function, which could allow Authors’ contributions
AC, EF and FL coordinated the Special Issue, conceived the Editorial and
for their early detection and trigger proper interventions. participated in manuscript drafting and revising. All authors read and
approved the final manuscript

Acknowledgements Funding
SCOPE study investigators. SCOPE study and publication costs are funded by the European Union
Coordinating center, Fabrizia Lattanzio, Italian National Research Center on Horizon 2020 program, under the Grant Agreement n° 634869. Funding
Aging (IRCCS INRCA), Ancona, Italy – Principal Investigator. Andrea body had no role in the design of the study and collection, analysis, and
Corsonello, Silvia Bustacchini, Silvia Bolognini, Paola D’Ascoli, Raffaella Moresi, interpretation of data, writing the manuscript and in the decision to publish
Giuseppina Di Stefano, Cinzia Giammarchi, Anna Rita Bonfigli, Roberta the results.
Galeazzi, Federica Lenci, Stefano Della Bella, Enrico Bordoni, Mauro
Provinciali, Robertina Giacconi, Cinzia Giuli, Demetrio Postacchini, Sabrina Availability of data and materials
Garasto, Annalisa Cozza, Francesco Guarasci, Sonia D’Alia - Italian National Not applicable.
Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy
– Coordinating staff. Romano Firmani, Moreno Nacciariti, Mirko Di Rosa,
Ethics approval and consent to participate
Paolo Fabbietti – Technical and statistical support. Participating centers
Not applicable.
● Department of Internal Medicine, Medical University of Graz, Austria:
Gerhard Hubert Wirnsberger, Regina Elisabeth Roller-Wirnsberger, Carolin
Herzog, Sonja Lindner Consent for publication
● Section of Geriatric Medicine, Department of Internal Medicine, Erasmus Not applicable.
MC, University Medical Center Rotterdam, The Netherlands: Francesco
Mattace-Raso, Lisanne Tap, Gijsbertus Ziere, Jeannette Goudzwaard. Competing interests
● Department of Geriatrics, Healthy Ageing Research Centre, Medical The authors declare that they have no competing interests.
University of Lodz, Poland: Tomasz Kostka, Agnieszka Guligowska, Łukasz
Kroc, Bartłomiej K Sołtysik, Małgorzata Pigłowska, Agnieszka Wójcik, Zuzanna Author details
Chrząstek, Natalia Sosowska, Anna Telążka, Joanna Kostka, Elizaveta Fife, 1
Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo
Katarzyna Smyj, Kinga Zel. and Cosenza, Cosenza, Italy. 2Department of Internal Medicine-Geriatrics,
● The Recanati School for Community Health Professions at the faculty of Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität
Health Sciences at Ben-Gurion University of the Negev, Israel: Rada Artzi- Erlangen-Nürnberg, Erlangen, Germany.
Medvedik, Yehudit Melzer, Mark Clarfield, Itshak Melzer; and Maccabi Health-
care services southern region, Israel: Rada Artzi-Medvedik, Ilan Yehoshua, Published: 2 October 2020
Yehudit Melzer.
● Geriatric Unit, Internal Medicine Department and Nephrology Department,
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