老年人群肾功能下降的异质性分析

摘要

Objective To study the rate of kidney function decline and the influencing factors in the aged population. Methods This was a prospective population-based study of 468 participants aged 65 years and older. All participants’ general health information and serum creatinine levels were collected as the baseline. After a 3-year follow-up ,the serum creatinine level of each participant was measured again.Kidney function was assessed with estimated glomerular filtration rate (eGFR) calculated using the Chronic Kidney Disease-Epidemiology Collaboration ( CKD-EPI ) equation. Outcomes of interest were mean eGFR decline and rapid decline in eGFR (annual eGFR loss≥3 ml·min－1·1.73 m －2).Risk factors were analyzed with Logistic regression. Results At baseline ,the mean age of participants was(78.4 ± 8.7)years and the mean eGFR was(74.8 ± 14.5)ml ·min－1·1.73 m －2.Annual eGFR decline was 1.5 ml·min－1·1.73 m －2,with rapid declines in 149 (32%) participants and stable kidney function in 319 (68%) individuals. The rate of kidney function loss slowed down as the age increased.Baseline eGFR was an independent predictor for rapid kidney function decline. The incidence of rapid kidney function decline in individuals with eGFR ≥ 60 ml· min－1·1.73 m －2was 2.40 times (95% CI :1.16-4.98) higher than that of participants with eGFR＜60 ml·min－1·1.73 m －2after adjustment for confounders. Conclusions Kidney function changes in the community-dwelling elderly in China are heterogeneous. Most elderly individuals do not show appreciable kidney function decline over a 3-year period.%目的 了解老年人群中肾功能下降速度及相关影响因素. 方法 收集社区老年人(≥65岁)健康查体资料,随访3年,观察其肾功能变化,评价其肾功能下降的特点和相关危险因素.肾功能评估采用慢性肾脏病流行病学合作研究公式(CKD-EPI)估算肾小球滤过率(eGFR) ,其中肾功能快速下降定义为eGFR下降≥3 ml·min－1·1.73 m －2/年. 结果 共468例入选,入选者平均年龄(78.4 ± 8.7)岁,基线时平均eGFR(74.8 ± 14.5)ml·min－1·1.73 m －2,eGFR下降平均为1.5 ml· min－1·1.73 m －2/年,149例(32%)研究对象出现肾功能快速下降,319例(68%)老年人肾功能相对稳定.随着年龄增长肾功能下降速度呈减速趋势,基线eGFR水平是肾功能快速下降的独立相关因素,基线eGFR相对好(≥ 60 ml·min－1·1.73 m －2)的人群肾功能快速下降的比例更高,是eGFR＜60 ml·min－1·1.73 m －2人群的2.40 (95% CI :1.16～4.98)倍. 结论 中国社区老年人群肾功能变化具有异质性,大部分社区老年人随访3年肾功能稳定.