Wolfgram Dawn F, Garcia Katelyn, Evans Greg, Zamanian Sara, Tang Rocky, Wiegmann Thomas, Sharma Rajeev, Campbell Ruth, Whittle Jeff
Medicine Division, Section of Nephrology, Milwaukee VA Medical Center, Milwaukee, WI, USA.
Am J Nephrol. 2017;45(2):172-179. doi: 10.1159/000455388. Epub 2017 Jan 21.
Chronic kidney disease (CKD) is increasingly common and disproportionately affects older adults. The contribution of kidney disease to the functional impairment noted in the elderly CKD population is unclear.
This is a cross-sectional analysis of a hypertensive cohort of people aged ≥75 years from the Systolic Blood Pressure Intervention Trial. We evaluated estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) as predictors of 3 measures of functional status: EuroQol-5 Dimensional (EQ-5D) score, Falls Efficacy Scale (FES) score, and gait speed. Linear regression models were used to evaluate the associations between our independent variables and outcome measures.
Our analysis included 2,620 participants, mean age of 79.9 (4.0) years. Unadjusted models showed that lower eGFR level and higher UACR level were associated with lower EQ-5D (p < 0.001 for both) and slower gait speed (p < 0.001 for both) and worse scores on FES (p = 0.032 and p = 0.039). In the fully adjusted models, higher levels of UACR remained significantly associated with lower EQ-5D scores and slower gait speed (p = 0.011 and p = 0.002, respectively). In contrast, level of eGFR was not associated with any functional outcome measures when accounting for covariates.
In individuals aged ≥75 years, albuminuria and eGFR were associated with impairments in physical performance and self-reported functional status; however, only the association with albuminuria remained after adjusting for relevant demographics and comorbidities. Evaluation of albuminuria may provide an additional tool for identifying older individuals at risk for functional impairment.
慢性肾脏病（CKD）日益常见，且对老年人的影响尤为严重。目前尚不清楚肾脏疾病对老年CKD患者功能损害的影响程度。
这是一项对收缩压干预试验中年龄≥75岁的高血压队列进行的横断面分析。我们评估了估计肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（UACR），以预测3种功能状态指标：欧洲五维健康量表（EQ-5D）评分、跌倒效能感量表（FES）评分和步态速度。采用线性回归模型评估自变量与结局指标之间的关联。
我们的分析纳入了2620名参与者，平均年龄为79.9（4.0）岁。未调整模型显示，较低的eGFR水平和较高的UACR水平与较低的EQ-5D评分相关（两者p<0.001）、较慢的步态速度相关（两者p<0.001）以及FES评分较差（p=0.032和p=0.039）。在完全调整模型中，较高的UACR水平仍与较低的EQ-5D评分和较慢的步态速度显著相关（分别为p=0.011和p=0.002）。相比之下，在考虑协变量后，eGFR水平与任何功能结局指标均无关联。
在年龄≥75岁的个体中，蛋白尿和eGFR与身体表现和自我报告的功能状态受损有关；然而，在调整相关人口统计学和合并症后，只有与蛋白尿的关联仍然存在。蛋白尿评估可为识别有功能损害风险的老年人提供额外的工具。
