老年与年轻成年人中经治疗和未经治疗的肾衰竭发生率。

Rates of treated and untreated kidney failure in older vs younger adults.

机构信息

Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

出版信息

JAMA. 2012 Jun 20;307(23):2507-15. doi: 10.1001/jama.2012.6455.

DOI:10.1001/jama.2012.6455

PMID:22797451

Abstract

CONTEXT

Studies of kidney failure in older adults have focused on receipt of dialysis, which may underestimate the burden of disease if older people are less likely to receive treatment.

OBJECTIVE

To determine the extent to which age is associated with the likelihood of treatment of kidney failure.

DESIGN, SETTING, AND PARTICIPANTS: Community-based cohort study of 1,816,824 adults in Alberta, Canada, who had outpatient estimated glomerular filtration rate (eGFR) measured between May 1, 2002, and March 31, 2008, with a baseline eGFR of 15 mL/min/1.73 m2 or higher and who did not require renal replacement therapy at baseline. Age was categorized as 18 to 44, 45 to 54, 55 to 64, 65 to 74, 75 to 84, and 85 or more years and eGFR as 90 or higher, 60 to 89, 45 to 59, 30 to 44, and 15 to 29 mL/min/1.73 m2.

MAIN OUTCOME MEASURES

Adjusted rates of treated kidney failure (receipt of dialysis or kidney transplantation), untreated kidney failure (progression to eGFR <15 mL/min/1.73 m2 without renal replacement therapy), and death.

RESULTS

During a median follow-up of 4.4 years, 97,451 (5.36%) died, 3295 (0.18%) developed kidney failure that was treated and 3116 (0.17%) developed kidney failure that went untreated. Within each eGFR stratum the rate of treated kidney failure was higher in younger compared with older people. For example, in the lowest eGFR stratum (15-29 mL/min/1.73 m2), adjusted rates of treated kidney failure were more than 10-fold higher among the youngest (18-44 years) compared with the oldest (≥85 years) groups (adjusted rate, 24.00 [95% CI, 14.78-38.97] vs 1.53 [95% CI, 0.59-3.99] per 1000 person-years, respectively; P < .001). Rates of untreated kidney failure were consistently higher at older ages. In the eGFR stratum of 15 to 29 mL/min/1.73 m2, adjusted rates of untreated kidney failure were more than 5-fold higher among the oldest (≥85 years), compared with the youngest (18-44 years) groups (adjusted rate, 19.95 [95% CI, 15.79-25.19] vs 3.53 [95% CI, 1.56-8.01] per 1000 person-years, respectively; P < .001). Rates of kidney failure overall (treated and untreated combined) demonstrated less variation across age groups; eg, the adjusted rate per 1000 person years for those with eGFR of 15-29 mL/min/1.73 m2 was 36.45 (95% CI, 24.46-54.32) among participants aged 18 to 44 years and 20.19 (95% CI, 15.27-26.69) among those aged 85 years or older (P = .01).

CONCLUSION

In Alberta, Canada, rates of untreated kidney failure are significantly higher in older compared with younger individuals.

摘要

背景

对老年肾衰竭患者的研究主要集中在接受透析治疗上，如果老年人接受治疗的可能性较低，那么这可能会低估疾病的负担。

目的

确定年龄与肾衰竭治疗可能性之间的关系。

设计、地点和参与者：这是一项基于人群的队列研究，纳入了加拿大阿尔伯塔省的 1816824 名成年人，他们在 2002 年 5 月 1 日至 2008 年 3 月 31 日期间进行了门诊估计肾小球滤过率（eGFR）测量，基线 eGFR 为 15ml/min/1.73m2 或更高，并且基线时不需要肾脏替代治疗。年龄分为 18 至 44 岁、45 至 54 岁、55 至 64 岁、65 至 74 岁、75 岁及以上，eGFR 分为 90 或更高、60 至 89、45 至 59、30 至 44 和 15 至 29ml/min/1.73m2。

主要观察指标

调整后的治疗性肾衰竭（接受透析或肾移植）、未治疗性肾衰竭（未经肾脏替代治疗而 eGFR 下降至 15ml/min/1.73m2 以下）和死亡的发生率。

结果

在中位随访 4.4 年期间，97451 人（5.36%）死亡，3295 人（0.18%）发生可治疗的肾衰竭，3116 人（0.17%）发生未经治疗的肾衰竭。在每个 eGFR 分层中，年轻患者的治疗性肾衰竭发生率均高于老年患者。例如，在最低 eGFR 分层（15-29ml/min/1.73m2）中，最年轻（18-44 岁）组与最年长（≥85 岁）组之间的治疗性肾衰竭调整发生率相差 10 多倍（调整率分别为 24.00[95%CI，14.78-38.97]和 1.53[95%CI，0.59-3.99]/1000 人年；P<0.001）。未治疗性肾衰竭的发生率在老年时始终较高。在 eGFR 分层为 15-29ml/min/1.73m2 时，最年长（≥85 岁）组与最年轻（18-44 岁）组之间的未治疗性肾衰竭调整发生率相差 5 多倍（调整率分别为 19.95[95%CI，15.79-25.19]和 3.53[95%CI，1.56-8.01]/1000 人年；P<0.001）。总体肾衰竭（治疗和未治疗合并）在各年龄组之间的变化较小；例如，在 eGFR 为 15-29ml/min/1.73m2 的患者中，18-44 岁患者的调整率为 36.45（95%CI，24.46-54.32），85 岁及以上患者的调整率为 20.19（95%CI，15.27-26.69）（P=0.01）。