Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA.
Clin J Am Soc Nephrol. 2011 Dec;6(12):2822-8. doi: 10.2215/CJN.06770711. Epub 2011 Oct 27.
It has been suggested that moderate reductions in estimated GFR (eGFR) among older adults may not reflect chronic kidney disease (CKD).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We examined age-specific (<60, 60 to 69, 70 to 79, and ≥80 years) associations between eGFR level and six concurrent CKD complications among 30,528 participants from the National Health and Nutrition Examination Survey (NHANES) 1988 to 1994 and 1999 to 2006 (n = 8242 from NHANES 2003 to 2006 for hyperparathyroidism). Complications included anemia (hemoglobin <12 g/dl women, <13.5 g/dl men), acidosis (bicarbonate <22 mEq/L), hyperphosphatemia (phosphorus ≥4.5 mg/dl), hypoalbuminemia (albumin <3.5 mg/dl), hyperparathyroidism (intact parathyroid hormone ≥70 pg/ml), and hypertension (systolic/diastolic BP ≥140/90 mmHg or antihypertensive use).
Among participants ≥80 years old, compared with those with estimated GFR (eGFR) ≥60 ml/min per 1.73 m(2), the multivariable adjusted prevalence ratios (95% confidence interval) associated with eGFR levels of 45 to 59 and <45 ml/min per 1.73 m(2) were 1.39 (1.11 to1.73) and 2.06 (1.59 to 2.67) for anemia, 1.33 (0.89 to 1.98) and 2.47 (1.52 to 4.00) for acidosis, 1.11 (0.70 to 1.76) and 2.16 (1.36 to 3.42) for hyperphosphatemia, 2.04 (1.39 to 3.00) and 2.83 (1.76 to 4.53) for hyperparathyroidism and 1.09 (1.03 to 1.14), and 1.12 (1.05 to 1.19) for hypertension, respectively. Higher prevalence ratios for these complications at lower eGFR levels were also present at younger ages. Reduced eGFR was associated with hypoalbuminemia only for adults <70.
Reduced eGFR was associated with a higher prevalence of several concurrent CKD complications, regardless of age.
有人认为，老年人估算肾小球滤过率（eGFR）的适度降低可能不能反映慢性肾脏病（CKD）。
设计、地点、参与者和测量：我们检查了来自国家健康和营养检查调查（NHANES）1988 年至 1994 年和 1999 年至 2006 年（NHANES 2003 年至 2006 年用于甲状旁腺功能亢进症的 8242 名参与者）中 60 岁以下、60 至 69 岁、70 至 79 岁和≥80 岁的年龄特异性（<60、60 至 69、70 至 79 和≥80 岁）与 eGFR 水平和同时存在的 CKD 并发症之间的关联。并发症包括贫血（女性血红蛋白<12 g/dl，男性血红蛋白<13.5 g/dl）、酸中毒（碳酸氢盐<22 mEq/L）、高磷血症（磷≥4.5 mg/dl）、低白蛋白血症（白蛋白<3.5 mg/dl）、甲状旁腺功能亢进症（完整甲状旁腺激素≥70 pg/ml）和高血压（收缩压/舒张压≥140/90 mmHg 或使用抗高血压药物）。
在≥80 岁的参与者中，与 eGFR（肾小球滤过率）≥60 ml/min/1.73 m²相比，eGFR 水平为 45 至 59 和<45 ml/min/1.73 m²的多变量调整患病率比（95%置信区间）分别为 1.39（1.11 至 1.73）和 2.06（1.59 至 2.67）贫血，1.33（0.89 至 1.98）和 2.47（1.52 至 4.00）酸中毒，1.11（0.70 至 1.76）和 2.16（1.36 至 3.42）高磷血症，2.04（1.39 至 3.00）和 2.83（1.76 至 4.53）甲状旁腺功能亢进症和 1.09（1.03 至 1.14）和 1.12（1.05 至 1.19）高血压。在较年轻的年龄，较低的 eGFR 水平与这些并发症的更高患病率比值也存在。与<70 岁的成年人相比，降低的 eGFR 仅与低白蛋白血症有关。
无论年龄大小，降低的 eGFR 与多种同时存在的 CKD 并发症的患病率较高有关。
