Kagiyama Shuntaro, Matsumura Kiyoshi, Ansai Toshihiro, Soh Inho, Takata Yutaka, Awano Shuji, Sonoki Kazuo, Yoshida Akihiro, Takehara Tadamichi, Iida Mitsuo
Division of General Internal Medicine, Department of Health Promotion, Science of Health Improvement, Kyushu Dental College, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan.
Hypertens Res. 2008 Nov;31(11):2053-8. doi: 10.1291/hypres.31.2053.
Chronic kidney disease (CKD) is one of the greatest risk factors for cardiovascular disease (CVD). The contribution of CKD to CVD mortality is not well understood in very elderly patients. Our study examined whether CKD might be a risk factor for total and CVD mortality in very elderly Japanese individuals. A total of 621 participants were enrolled, all of whom were 80 years old. The subjects were divided on the basis of the presence (CKD(+) group, n=280) or absence (CKD(-) group, n=341) of CKD. CKD was defined by as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m(2). The eGFR of the CKD(+) and CKD(-) groups was 49.7+/-8.5 and 70.9+/-9.5 mL/min/1.73 m(2), respectively. During the 4-year study period, 87 individuals died, and 25 of those deaths were due to CVD. A Cox multivariate regression analysis revealed no association between total mortality and CKD (relative risk [RR] 1.17, confidence interval [CI] 0.75-1.82, p=0.50). However, the CVD mortality was significantly increased in the CKD(+) group (RR 4.60, CI 1.69-12.52, p=0.003). CKD significantly increased the CVD mortality in subjects who were not taking antihypertensive medication (RR 5.15, CI 1.04-25.50, p=0.04). Our results suggest that CKD increases the risk of CVD mortality in very elderly individuals. It is not only important to prevent progression toward CKD in patients who do not suffer from CKD, but also critical to manage the risk factors for CVD in patients with CKD, despite their advanced age. (Hypertens Res 2008; 31: 2053-2058).
慢性肾脏病（CKD）是心血管疾病（CVD）的最大危险因素之一。在高龄患者中，CKD对CVD死亡率的影响尚不清楚。我们的研究调查了CKD是否可能是日本高龄个体全因死亡率和CVD死亡率的危险因素。共纳入621名参与者，他们均为80岁。根据是否存在CKD将受试者分为两组（CKD(+)组，n = 280；CKD(-)组，n = 341）。CKD定义为估算肾小球滤过率（eGFR）低于60 mL/min/1.73 m²。CKD(+)组和CKD(-)组的eGFR分别为49.7±8.5和70.9±9.5 mL/min/1.73 m²。在4年的研究期间，87人死亡，其中25例死于CVD。Cox多因素回归分析显示全因死亡率与CKD之间无关联（相对风险[RR] 1.17，置信区间[CI] 0.75 - 1.82，p = 0.50）。然而，CKD(+)组的CVD死亡率显著增加（RR 4.60，CI 1.69 - 12.52，p = （《高血压研究》2008年；31：2053 - 2058）。 0.003）。在未服用抗高血压药物的受试者中，CKD显著增加了CVD死亡率（RR 5.15，CI 1.04 - 25.50，p = 0.04）。我们的结果表明，CKD增加了高龄个体CVD死亡风险。对于未患CKD的患者，不仅要预防疾病进展为CKD，对于CKD患者，尽管年龄较大，控制CVD危险因素也至关重要。
