Carter Joanne L, O'Riordan Shelagh E, Eaglestone Gillian L, Delaney Michael P, Lamb Edmund J
Departments of Clinical Biochemistry, east Kent Hospitals NHS Trust, Canterbury, Kent, CT1 3NG, United Kingdom.
Nephrol Dial Transplant. 2008 Apr;23(4):1257-64. doi: 10.1093/ndt/gfm792. Epub 2007 Nov 19.
Chronic kidney disease (CKD) is common ( approximately 30%) in non-institutionalized older people but little is known about the prevalence of CKD amongst older people living in residential care.
An observational study of older subjects [n = 250, median age 86 (range 67-100) years, 79% female, 100% Caucasian, 16% diabetic, 48% hypertensive, 5% known renal disease, mean number of medications 7] who were recruited over a 9-month period from 155 residential care homes in east Kent (total population 3811) using a randomization process. The estimated glomerular filtration rate (eGFR, ml/min/1.73 m(2)) was calculated using the Cockcroft and Gault equation corrected for the body surface area and the simplified Modification of Diet in Renal Disease (MDRD) Study equation. Serum cystatin C concentration was also measured.
Using the MDRD equation 18% had eGFR >/=60, 39% stage 3A CKD (eGFR 45-59), 34% stage 3B CKD (eGFR 30-44) and 10% stage 4 CKD (eGFR 15-29). By the Cockcroft-Gault equation the equivalent figures were 3%, 18%, 48% and 31%, respectively. Agreement between the equations for staging of CKD was poor (kappa = 0.07). However, >80% of residents were categorized as having stage 3 CKD (>40% stage 3B) or worse whichever equation was used. Serum cystatin C concentration was increased in 92% of the population. Increasing age and higher body mass index were predictive of decreased renal function.
Significant CKD is prevalent and unrecognized in this population. This may have important management implications particularly for treatment with renally excreted drugs, fracture prevention or managing cardiovascular risk.
慢性肾脏病（CKD）在非机构化的老年人中很常见（约30%），但对于住在养老院的老年人中CKD的患病率知之甚少。
对年龄较大的受试者进行一项观察性研究[n = 250，年龄中位数86岁（范围67 - 100岁），79%为女性，100%为白种人，16%患有糖尿病，48%患有高血压，5%患有已知肾脏疾病，平均用药数量为7种]，这些受试者是在9个月的时间里从肯特郡东部155家养老院（总人口3811人）中通过随机化过程招募的。使用经体表面积校正的Cockcroft和Gault方程以及简化的肾脏疾病饮食改良（MDRD）研究方程计算估算肾小球滤过率（eGFR，ml/min/1.73 m²）。还测量了血清胱抑素C浓度。
使用MDRD方程，18%的人eGFR≥60，39%为3A期CKD（eGFR 45 - 59），34%为3B期CKD（eGFR 30 - 44），10%为4期CKD（eGFR 15 - 29）。通过Cockcroft - Gault方程得出的相应数字分别为3%、18%、48%和31%。CKD分期方程之间的一致性较差（kappa = 0.07）。然而，无论使用哪个方程，超过80%的居民被归类为患有3期CKD（超过40%为3B期）或更严重。92%的人群血清胱抑素C浓度升高。年龄增加和体重指数升高是肾功能下降的预测因素。
在该人群中，严重CKD普遍存在且未被识别。这可能对管理有重要影响，特别是对于经肾脏排泄药物的治疗、骨折预防或心血管风险管理。
