Kurella Manjula, Ireland Christine, Hlatky Mark A, Shlipak Michael G, Yaffe Kristine, Hulley Stephen B, Chertow Glenn M
Department of Medicine, University of California San Francisco, San Francisco, CA 94118-1211, USA
Am J Kidney Dis. 2004 May;43(5):868-76. doi: 10.1053/j.ajkd.2003.12.050.
Cross-sectional studies suggest an association between functional status and chronic kidney disease (CKD). Whether physical function deteriorates with progression of CKD is unknown.
To determine associations among CKD, physical function, and sexual function in women, we conducted cross-sectional and longitudinal analyses of 2,761 women enrolled in the Heart and Estrogen/Progestin Replacement Study. Physical and sexual function were evaluated using the Duke Activity Status Index (DASI) and the Sexual Problems Scale of the Medical Outcomes Study, respectively. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease regression equation. In addition to analyses across the spectrum of GFR, CKD was categorized as mild (estimated GFR, 45 to 60 mL/min/1.73 m2), moderate (estimated GFR, 30 to 44 mL/min/1.73 m2), and severe (estimated GFR, <30 mL/min/1.73 m2) according to a modification of recently established classification guidelines.
Mean age of study participants was 67 +/- 7 years, and mean estimated GFR was 61 +/- 14 mL/min/1.73 m2. In unadjusted analyses, mean baseline DASI score was 10 points lower in women with an estimated GFR less than 30 mL/min/1.73 m2 than in women with an estimated GFR of 60 mL/min/1.73 m2 or greater (P < 0.0001). Estimated GFR remained significantly associated with DASI score after multivariable adjustment. In longitudinal analyses, a decline in estimated GFR was associated with a significant decline in DASI score independent of baseline estimated GFR and other factors. There were no significant associations between estimated GFR and psychosocial aspects of sexual function.
CKD is associated with impaired physical function, and a decline in estimated GFR is associated with a decline in physical function.
横断面研究表明功能状态与慢性肾脏病（CKD）之间存在关联。身体功能是否会随着CKD的进展而恶化尚不清楚。
为了确定CKD、身体功能和女性性功能之间的关联，我们对参加心脏和雌激素/孕激素替代研究的2761名女性进行了横断面和纵向分析。分别使用杜克活动状态指数（DASI）和医学结局研究的性功能问题量表评估身体功能和性功能。使用肾脏病饮食改良回归方程估算肾小球滤过率（GFR）。除了对GFR范围进行分析外，根据最近制定的分类指南的修改版，将CKD分为轻度（估算GFR，45至60 mL/ min/1.73 m²）、中度（估算GFR，30至44 mL/ min/1.73 m²）和重度（估算GFR，<30 mL/ min/1.73 m²）。
研究参与者的平均年龄为67±7岁，平均估算GFR为61±14 mL/ min/1.73 m²。在未调整的分析中，估算GFR低于30 mL/ min/1.73 m²的女性的平均基线DASI评分比估算GFR为60 mL/ min/1.73 m²或更高的女性低10分（P<0.0001）。多变量调整后，估算GFR仍与DASI评分显著相关。在纵向分析中，估算GFR的下降与DASI评分的显著下降相关，且与基线估算GFR和其他因素无关。估算GFR与性功能的心理社会方面之间无显著关联。
CKD与身体功能受损有关，估算GFR的下降与身体功能的下降有关。
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