Department of Nephrology, Necker-Enfants Malades Hospital, Assistance Publique, Hopitaux de Paris, Paris, France.
J Am Geriatr Soc. 2009 Dec;57(12):2217-23. doi: 10.1111/j.1532-5415.2009.02561.x.
To determine whether a subgroup of patients with severe but nonprogressive renal dysfunction exist and to characterize this subgroup.
Retrospective longitudinal monocentric cohort study.
Nephrology clinic for chronic kidney disease (CKD).
Between January 1998 and December 2004, 177 consecutive patients aged 80 and older were referred for the first time to nephrology for CKD.
The characteristics of patients with nonprogressive or progressive CKD (estimated glomerular filtration rate (eGFR) decline of < and > or =1 mL/min per 1.73 m(2) per year, respectively) were observed and analyzed, and their risk of dying or requiring dialysis was determined. After exclusion of subjects requiring immediate dialysis or followed up for less than 6 months, 138 patients remained eligible for analysis.
In the study cohort (initial mean eGFR 31.8 mL/min per 1.73 m(2), median follow-up 47 months), patients were more likely to require dialysis than to die; 36% of patients had nonprogressive CKD. This characteristic, predicted by low proteinuria, lack of hypertension, and low cardiovascular comorbidity, was the strongest predictor of global survival. In progressors, two independent covariates (eGFR <30 mL/min per 1.73 m(2) and hemoglobin < or =11 g/dL at inclusion) predicted the risk of requiring dialysis.
More than one-third of subjects aged 80 and older referred to a nephrology center had severe but nonprogressive kidney dysfunction. This subgroup had a lower mortality rate than those with progressive kidney dysfunction. Simple covariates (low proteinuria, lack of hypertension, low cardiovascular comorbidity) predicted nonprogression of CKD. Distant nephrology follow-up of such patients may be sufficient.
确定是否存在一组严重但肾功能无进展的患者亚组，并对该亚组进行特征描述。
回顾性纵向单中心队列研究。
慢性肾脏病（CKD）肾病科。
1998 年 1 月至 2004 年 12 月期间，首次因 CKD 被转至肾病科的 177 例 80 岁及以上连续患者。
观察并分析肾功能无进展或进展患者（估算肾小球滤过率（eGFR）下降分别为 < 和 >或 =1 mL/min/1.73 m2/年）的特征，并确定其死亡或需要透析的风险。排除需要立即透析或随访时间<6 个月的患者后，138 例患者符合分析条件。
在研究队列中（初始平均 eGFR 为 31.8 mL/min/1.73 m2，中位随访时间为 47 个月），患者需要透析的可能性高于死亡；36%的患者存在肾功能无进展性 CKD。该特征由低蛋白尿、无高血压和低心血管合并症预测，是总体生存的最强预测因子。在进展患者中，两个独立的协变量（eGFR <30 mL/min/1.73 m2 和纳入时血红蛋白 <或 =11 g/dL）预测了需要透析的风险。
超过三分之一被转至肾病科的 80 岁及以上患者存在严重但肾功能无进展的情况。该亚组的死亡率低于肾功能进行性下降患者。简单的协变量（低蛋白尿、无高血压、低心血管合并症）可预测 CKD 无进展。对这类患者进行远程肾病随访可能就足够了。
Zotero 插件