Istituto Nazionale di Ricovero e Cura per Anziani, C.da Muoio Piccolo, I-87100 Cosenza, Italy.
Chest. 2010 Apr;137(4):831-7. doi: 10.1378/chest.09-1710. Epub 2009 Nov 10.
To the best of our knowledge, the association between COPD and chronic renal failure (CRF) has never been assessed. Lean mass is frequently reduced in COPD, and the glomerular filtration rate (GFR) might be depressed in spite of normal serum creatinine (concealed CRF). We investigated the prevalence and correlates of both concealed and overt CRF in elderly patients with COPD.
We evaluated 356 consecutive elderly outpatients with COPD enrolled in the Extrapulmonary Consequences of COPD in the Elderly Study and 290 age-matched outpatients free from COPD. The GFR was estimated using the Modification of Diet in Renal Disease Study Group equation. Patients were categorized as having normal renal function (GFR > or = 60 mL/min/1.73 m(2)), concealed CRF (normal serum creatinine and reduced GFR), or overt CRF (increased serum creatinine and reduced GFR). Independent correlates of CRF were investigated by logistic regression analysis.
The prevalence of concealed and overt CRF in patients with COPD was 20.8% and 22.2%, respectively. Corresponding figures in controls were 10.0% and 13.4%, respectively. COPD and age were significantly associated with both concealed CRF (COPD: odds ratio [OR] = 2.19, 95% CI = 1.17-4.12; age: OR = 1.06, 95% CI = 1.04-1.09) and overt CRF (COPD: OR = 1.94, 95% CI = 1.01-4.66; age: OR = 1.06, 95% CI = 1.04-1.10). Diabetes (OR = 1.96, 95% CI = 1.02-3.76), hypoalbuminemia (OR = 2.83, 95% CI = 1.70-4.73), and muscle-skeletal diseases (OR = 1.78, 95% CI = 1.01-3.16) were significant correlates of concealed CRF. BMI (OR = 1.05, 95% CI = 1.01-1.10) and diabetes (OR = 2.25, 95% CI = 1.26-4.03) were significantly associated with overt CRF.
CRF is highly prevalent in patients with COPD, even with normal serum creatinine, and might contribute to explaining selected conditions such as anemia that are frequent complications of COPD.
据我们所知，COPD 和慢性肾功能衰竭（CRF）之间的关联从未被评估过。在 COPD 中，瘦体重经常减少，尽管血清肌酐正常（隐匿性 CRF），肾小球滤过率（GFR）可能降低。我们研究了老年 COPD 患者中隐匿性和显性 CRF 的患病率及其相关因素。
我们评估了参加肺外 COPD 老年患者研究的 356 例连续老年 COPD 门诊患者和 290 例年龄匹配且无 COPD 的门诊患者。使用肾脏病饮食改良研究组方程估计 GFR。将患者分为肾功能正常（GFR >或= 60 mL/min/1.73 m(2)）、隐匿性 CRF（正常血清肌酐和降低的 GFR）或显性 CRF（增加的血清肌酐和降低的 GFR）。通过逻辑回归分析探讨 CRF 的独立相关因素。
COPD 患者隐匿性和显性 CRF 的患病率分别为 20.8%和 22.2%，对照组分别为 10.0%和 13.4%。COPD 和年龄与隐匿性 CRF（COPD：比值比[OR] = 2.19，95%置信区间[CI] = 1.17-4.12；年龄：OR = 1.06，95%CI = 1.04-1.09）和显性 CRF（COPD：OR = 1.94，95%CI = 1.01-4.66；年龄：OR = 1.06，95%CI = 1.04-1.10）显著相关。糖尿病（OR = 1.96，95%CI = 1.02-3.76）、低白蛋白血症（OR = 2.83，95%CI = 1.70-4.73）和肌肉骨骼疾病（OR = 1.78，95%CI = 1.01-3.16）是隐匿性 CRF 的显著相关因素。BMI（OR = 1.05，95%CI = 1.01-1.10）和糖尿病（OR = 2.25，95%CI = 1.26-4.03）与显性 CRF 显著相关。
CRF 在 COPD 患者中患病率很高，即使血清肌酐正常，也可能有助于解释贫血等 COPD 的常见并发症等某些情况。
