Chronic kidney disease in older people with intellectual disability: results of the HA-ID study.
Add cystatin-C to creatinine when you check kidney function in sarcopenic older adults with ID.
01Research in Context
What this study did
Andrade et al. (2014) checked kidney health in 635 older Dutch adults with intellectual disability. They compared two blood tests: the usual creatinine and the newer cystatin-C. All lived in residential centers.
The team wanted to know if creatinine alone misses sick kidneys in people with low muscle mass.
What they found
Fifteen percent had chronic kidney disease, same as the general older population. Creatinine-only equations under-counted the sick kidneys in sarcopenic clients. Adding cystatin-C caught the missed cases.
How this fits with other research
Lin et al. (2010) saw one in five teens with ID already had high creatinine. They used creatinine alone, so they likely missed early damage the way F et al. warn.
Hanson et al. (2013) studied sleep in the same Dutch HA-ID cohort. Both papers show this group needs wide health screens, not just one organ check.
Sandberg et al. (2026) later confirmed most body systems break down faster in ID. Their registry data back F et al.'s call for tighter kidney tracking.
Why it matters
If you support older adults with ID, order both creatinine and cystatin-C before saying kidneys are fine. Low muscle can hide disease when you rely on creatinine alone. Catching CKD early means fewer ER trips, less polypharmacy, and slower dialysis starts. Add this dual test to annual labs for any sarcopenic client.
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02At a glance
03Original abstract
With increasing longevity and cardiovascular events, chronic kidney disease may also become a significant problem in older people with intellectual disability (ID). We studied prevalence and associations of chronic kidney disease as part of the Healthy Ageing and Intellectual Disability (HA-ID) study, a large Dutch cross-sectional study among people with ID aged 50 years and over, using creatinine and cystatin-C measurement in plasma. Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Equations based on creatinine (as the MDRD equation) may underestimate kidney dysfunction in people with sarcopenia, because low muscle mass leads to a low creatinine production. Therefore, also prevalence of chronic kidney disease was studied in the sarcopenic group, using different GFR equations. Prevalence of chronic kidney disease, among 635 participants, was 15.3%, which equals prevalence in the general Dutch population. In the group of participants with sarcopenia (n=82), the CKD-EPI equation based on creatinine and cystatin-C gave a higher prevalence of chronic kidney disease than did the MDRD equation, but confidence intervals were very wide. Chronic kidney disease was associated with higher age, Down syndrome, obesity, hypercholesterolemia and hypothyroid disease. GFR should be measured in all older people with ID and polypharmacy, and in older people with ID and Down syndrome as part of the regular health checks. Moreover, if sarcopenia is present and information on GFR is required, this should not be measured based on creatinine only, but additional measures, such as cystatin-C, should be taken into account.
Research in developmental disabilities, 2014 · doi:10.1016/j.ridd.2013.11.005