O'Hare Ann M, Choi Andy I, Bertenthal Daniel, Bacchetti Peter, Garg Amit X, Kaufman James S, Walter Louise C, Mehta Kala M, Steinman Michael A, Allon Michael, McClellan William M, Landefeld C Seth
Department of Medicine, University of Washington, VA Puget Sound Healthcare System, Division of Nephrology, Building 100 Room 5B113, 1660 S. Columbian Way, Seattle, WA 98108, USA.
J Am Soc Nephrol. 2007 Oct;18(10):2758-65. doi: 10.1681/ASN.2007040422. Epub 2007 Sep 12.
Chronic kidney disease (CKD) is common among the elderly. However, little is known about how the clinical implications of CKD vary with age. We examined the age-specific incidence of death, treated end-stage renal disease (ESRD), and change in estimated glomerular filtration rate (eGFR) among 209,622 US veterans with CKD stages 3 to 5 followed for a mean of 3.2 years. Patients aged 75 years or older at baseline comprised 47% of the overall cohort and accounted for 28% of the 9227 cases of ESRD that occurred during follow-up. Among patients of all ages, rates of both death and ESRD were inversely related to eGFR at baseline. However, among those with comparable levels of eGFR, older patients had higher rates of death and lower rates of ESRD than younger patients. Consequently, the level of eGFR below which the risk of ESRD exceeded the risk of death varied by age, ranging from 45 ml/min per 1.73 m(2) for 18 to 44 year old patients to 15 ml/min per 1.73 m(2) for 65 to 84 year old patients. Among those 85 years or older, the risk of death always exceeded the risk of ESRD in this cohort. Among patients with eGFR levels <45 ml/min per 1.73 m(2) at baseline, older patients were less likely than their younger counterparts to experience an annual decline in eGFR of >3 ml/min per 1.73 m(2). In conclusion, age is a major effect modifier among patients with an eGFR of <60 ml/min per 1.73 m(2), challenging us to move beyond a uniform stage-based approach to managing CKD.
慢性肾脏病（CKD）在老年人中很常见。然而，关于CKD的临床意义如何随年龄变化却知之甚少。我们研究了209,622名美国3至5期CKD退伍军人的年龄特异性死亡率、接受治疗的终末期肾病（ESRD）发生率以及估算肾小球滤过率（eGFR）的变化情况，随访时间平均为3.2年。基线时年龄在75岁及以上的患者占整个队列的47%，在随访期间发生的9227例ESRD病例中占28%。在所有年龄段的患者中，死亡率和ESRD发生率均与基线时的eGFR呈负相关。然而，在eGFR水平相当的患者中，老年患者的死亡率高于年轻患者，而ESRD发生率低于年轻患者。因此，ESRD风险超过死亡风险的eGFR水平因年龄而异，18至44岁患者为45 ml/min per 1.73 m²，65至84岁患者为15 ml/min per 1.73 m²。在85岁及以上的患者中，该队列中死亡风险始终超过ESRD风险。在基线时eGFR水平<45 ml/min per 1.73 m²的患者中，老年患者比年轻患者每年eGFR下降>3 ml/min per 1.73 m²的可能性更小。总之，年龄是eGFR<60 ml/min per 1.73 m²患者的一个主要效应修饰因素，这促使我们超越统一的基于分期的方法来管理CKD。
