老年女性的肾功能与无残疾生存期
Kidney Function and Disability-Free Survival in Older Women.
作者信息
Cavanaugh Alyson M, LaCroix Andrea Z, Kritz-Silverstein Donna, Rillamas-Sun Eileen, Rifkin Dena E
机构信息
Joint Doctoral Program in Public Health (Epidemiology), San Diego State University/University of California, San Diego, California.
Division of Nephrology and Division of Preventive Medicine, UC San Diego, and Veterans' Affairs Healthcare System, San Diego, California.
出版信息
J Am Geriatr Soc. 2017 Jan;65(1):98-106. doi: 10.1111/jgs.14433. Epub 2016 Sep 21.
OBJECTIVES
To examine the prospective association between kidney function and three outcomes: survival to age 85 with functional independence, survival to age 85 with disability, and death before age 85.
DESIGN
Prospective study.
SETTING
Women's Health Initiative, conducted at 40 U.S. clinical centers.
PARTICIPANTS
Postmenopausal women enrolled between 1993 and 1998 with baseline biomarker assessments who had the potential to reach age 85 before September 2013 (N = 7,178).
MEASUREMENTS
Kidney function was measured according to estimated glomerular filtration rate (eGFR) calculated from serum creatinine collected at baseline. Outcomes were survival to age 85 with functional independence, survival with disability, or death before age 85. Disability was defined as mobility or activity of daily living limitations measured by questionnaire.
RESULTS
eGFR was greater than 90 mL/min per 1.73 m in 22.7% of women, 60 to 89 mL/min per 1.73 m in 66.5%, 45 to 59 mL/min per 1.73 m in 8.7%, and less than 45 mL/min per 1.73 m in 2.0%. Median follow-up was 15 years. Of 4,953 survivors, 3,155 reported no physical disability at age 85. Two thousand two hundred twenty-five participants died before age 85. Women with an eGFR of 90 mL/min per 1.73 m or greater had 2.71 times greater odds of survival to age 85 with functional independence than of dying before 85 (95% confidence interval (CI) = 1.62-4.51) than those with an eGFR less than 45 mL/min per 1.73 m , women with an eGFR of 60 to 89 mL/min per 1.73 m had 3.04 times (95% CI = 1.85-5.00) greater odds, and women with an eGFR of 45 to 59 mL/min per 1.73 m had 2.22 times (95% CI = 1.31-3.76) greater odds. Similar, but slightly weaker odds were seen for survival to age 85 with disability. Better kidney function was not significantly associated with greater likelihood of survival to age 85 with independent function than of surviving with disability.
CONCLUSION
Better kidney function was associated with greater likelihood of survival to age 85 with and without disability.
目的
研究肾功能与三个结局之间的前瞻性关联，这三个结局分别是：活到85岁且功能独立、活到85岁但有残疾、85岁之前死亡。
设计
前瞻性研究。
地点
在美国40个临床中心开展的女性健康倡议研究。
参与者
1993年至1998年登记入组的绝经后女性，她们进行了基线生物标志物评估，且有可能在2013年9月前活到85岁（N = 7178）。
测量指标
根据基线时采集的血清肌酐计算的估计肾小球滤过率（eGFR）来测量肾功能。结局为活到85岁且功能独立、有残疾存活或85岁之前死亡。残疾定义为通过问卷测量的行动能力或日常生活活动受限。
结果
22.7%的女性eGFR大于90 ml/min/1.73 m²，66.5%的女性eGFR为60至89 ml/min/1.73 m²，8.7%的女性eGFR为45至59 ml/min/1.73 m²，2.0%的女性eGFR小于45 ml/min/1.73 m²。中位随访时间为15年。在4953名幸存者中，3155人在85岁时报告无身体残疾。2225名参与者在85岁之前死亡。eGFR为90 ml/min/1.73 m²或更高的女性活到85岁且功能独立的几率是在85岁之前死亡几率的2.71倍（95%置信区间（CI）= 1.62 - 4.51），高于eGFR小于45 ml/min/1.73 m²的女性；eGFR为60至89 ml/min/1.73 m²的女性活到85岁且功能独立的几率是其3.04倍（95% CI = 1.85 - 5.00）；eGFR为45至59 ml/min/1.73 m²的女性活到85岁且功能独立的几率是其2.22倍（95% CI = 1.31 - 3.76）。对于活到85岁且有残疾的情况，也观察到了类似但稍弱的几率。与有残疾存活相比，更好的肾功能与活到85岁且功能独立存活的可能性增加并无显著关联。
结论
更好的肾功能与活到85岁且无论有无残疾的存活可能性增加相关。
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