Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Clin J Am Soc Nephrol. 2011 Sep;6(9):2200-7. doi: 10.2215/CJN.02030311. Epub 2011 Jul 7.
It has been suggested that reduced estimated GFR (eGFR) among older adults does not necessarily reflect a pathologic phenomenon.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We examined the association between eGFR and albumin-to-creatinine ratio (ACR) and all-cause mortality stratified by age (45 to 59.9, 60 to 69.9, 70 to 79.9, and ≥80 years) among 24,350 U.S. adults in the population-based REasons for Geographic and Racial Differences in Stroke (REGARDS) study. A spot urine sample was used to calculate ACR, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to calculate eGFR. All-cause mortality was assessed over a median follow-up of 4.5 years.
Among participants ≥80 years of age (n = 1669), the age, race, gender, and geographic region of residence adjusted hazard ratios (95% confidence intervals) for mortality associated with eGFR levels of 45 to 59.9 and <45 ml/min per 1.73 m(2), versus ≥60 ml/min per 1.73 m(2), were 1.6 (1.3 - 2.1) and 2.2 (1.7 - 2.9), respectively. Also, among participants ≥80 years of age, the hazard ratios for mortality associated with ACR levels of 10 to 29.9, 30 to 299.9, and ≥300 mg/g, versus <10 mg/g, were 1.7 (1.3 - 2.1), 2.5 (1.9 - 3.3), and 5.1 (3.6 - 7.4), respectively. These associations were present after further multivariable adjustment and within the younger age groupings studied.
These data suggest that reduced eGFR and albuminuria confer an increased risk for mortality in all age groups, including adults ≥80 years of age.
有人认为，老年人估算肾小球滤过率（eGFR）降低并不一定反映病理性现象。
设计、地点、参与者和测量：我们在基于人群的中风地理和种族差异原因（REGARDS）研究中，检查了美国 24350 名成年人中 eGFR 与白蛋白-肌酐比值（ACR）之间的关系，并按年龄（45 至 59.9、60 至 69.9、70 至 79.9 和≥80 岁）进行分层。使用尿液样本检测 ACR，使用慢性肾脏病流行病学合作（CKD-EPI）方程计算 eGFR。在中位随访 4.5 年后评估全因死亡率。
在≥80 岁的参与者中（n=1669），年龄、种族、性别和居住地理区域调整后的死亡率与 eGFR 水平为 45 至 59.9 和<45 ml/min/1.73 m²，与≥60 ml/min/1.73 m²相比，危险比（95%置信区间）分别为 1.6（1.3-2.1）和 2.2（1.7-2.9）。同样，在≥80 岁的参与者中，ACR 水平为 10 至 29.9、30 至 299.9 和≥300 mg/g 与<10 mg/g 相比，死亡率的危险比分别为 1.7（1.3-2.1）、2.5（1.9-3.3）和 5.1（3.6-7.4）。这些关联在进一步的多变量调整后仍然存在，并且在研究的年轻年龄组中也是如此。
这些数据表明，eGFR 和白蛋白尿降低在所有年龄组中均增加死亡率风险，包括≥80 岁的成年人。
