Okparavero Aghogho, Foster Meredith C, Tighiouart Hocine, Gudnason Vilmundur, Indridason Olafur, Gudmundsdottir Hrefna, Eiriksdottir Gudny, Gudmundsson Elias F, Inker Lesley A, Levey Andrew S
Division of Nephrology, Tufts Medical Center, Boston, MA, USA.
The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA.
Nephrol Dial Transplant. 2016 Mar;31(3):439-47. doi: 10.1093/ndt/gfv370. Epub 2015 Oct 31.
Chronic kidney disease (CKD) is common in the elderly, but data are limited on the distribution of glomerular filtration rate (GFR) and albuminuria and the prevalence of CKD and related complications in this population.
A cross-sectional study of 3173 older Icelandic adults [42% men; mean (standard deviation, SD) age of 80 (5) years] was performed to examine the distribution of estimated glomerular filtration rate (eGFR) from creatinine and cystatin C, the albumin-to-creatinine ratio (ACR), and CKD-related metabolic complications (hyperparathyroidism, anemia, hypoalbuminemia, increased anion gap, acidosis, hyperphosphatemia and hyperkalemia).
There was substantial variability in eGFR [mean (SD) 64 (18) mL/min/1.73 m(2)] and ACR [median (interquartile range) 8 (5, 17) mg/g]. The prevalence (95% confidence interval) of reduced eGFR (<60 mL/min/1.73 m(2)), albuminuria (ACR >30 mg/g) and CKD (either reduced eGFR or albuminuria) was 40% (38-41), 14% (12-15) and 45% (43-47), respectively. The prevalence of complications was higher among those with versus without CKD: hyperparathyroidism (38 versus 15%), anemia (26 versus 14%), hypoalbuminemia (19 versus 13%), increased anion gap (9 versus 5%), acidosis (5 versus 1%); (P ≤ 0.02 for all), except hyperphosphatemia (1 versus 1%) and hyperkalemia (0% overall).
The burden of CKD and CKD-related complications is high among community dwelling elderly Icelandic adults. The wide range of eGFR and ACR suggests heterogeneity in processes leading to CKD and that factors beyond aging contribute to the development of CKD in the elderly.
慢性肾脏病（CKD）在老年人中很常见，但关于该人群肾小球滤过率（GFR）和蛋白尿的分布以及CKD及其相关并发症的患病率的数据有限。
对3173名冰岛老年成年人[42%为男性；平均（标准差，SD）年龄80（5）岁]进行了一项横断面研究，以检查基于肌酐和胱抑素C的估算肾小球滤过率（eGFR）、白蛋白与肌酐比值（ACR）以及CKD相关代谢并发症（甲状旁腺功能亢进、贫血、低白蛋白血症、阴离子间隙增加、酸中毒、高磷血症和高钾血症）的分布情况。
eGFR[平均（SD）64（18）mL/min/1.73 m²]和ACR[中位数（四分位间距）8（5，17）mg/g]存在很大差异。eGFR降低（<60 mL/min/1.73 m²）、蛋白尿（ACR>30 mg/g）和CKD（eGFR降低或蛋白尿）的患病率（95%置信区间）分别为40%（38 - 41）、14%（12 - 15）和45%（43 - 47）。有CKD者的并发症患病率高于无CKD者：甲状旁腺功能亢进（38%对15%）、贫血（26%对14%）、低白蛋白血症（19%对13%）、阴离子间隙增加（9%对5%）、酸中毒（5%对1%）；（所有P≤0.02），高磷血症（1%对1%）和高钾血症（总体为0%）除外。
在居住于社区的冰岛老年成年人中，CKD及其相关并发症的负担很重。eGFR和ACR的广泛范围表明导致CKD的过程存在异质性，且衰老以外的因素也促使老年人发生CKD。
