Canney Mark, Sexton Eithne, Tobin Katy, Kenny Rose Anne, Little Mark A, O'Seaghdha Conall M
The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland.
Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland.
Clin Kidney J. 2018 Apr;11(2):259-264. doi: 10.1093/ckj/sfx084. Epub 2017 Aug 4.
The impact of a diminished level of kidney function on the well-being of an older individual is poorly understood. We sought to determine the association between estimated glomerular filtration rate (eGFR) and overall quality of life (QoL) among older adults.
Cross-sectional analysis of 4293 participants from the Irish Longitudinal Study on Ageing, a population-based study of community-dwelling adults ≥50 years of age. We used multivariable negative binomial regression to model the relationship between categories of cystatin C eGFR (eGFR) or creatinine eGFR (eGFR) and the number of QoL deficits from the Control, Autonomy, Self-realization and Pleasure (CASP-19) scale, a holistic measure of QoL among older adults (range 0-57). We further explored this relationship across age strata.
Median age was 61 [interquartile range (IQR) 55-68] years, 53% were female, mean (SD) CASP-19 score was 44.8 (7.4) and median eGFR was 81 (IQR 68-93) mL/min/1.73 m. After multivariable adjustment, participants with eGFR <45 mL/min/1.73 m had 14% greater QoL deficits {incidence rate ratio 1.14 (95% confidence interval 1.03-1.25)] relative to the reference group (eGFR ≥90 mL/min/1.73 m). This relationship appeared linear across eGFR categories and was more pronounced in younger (50-64 years) compared with older participants (65-74 or ≥75 years). There was no substantive relationship between eGFR and CASP-19.
Cystatin C but not creatinine eGFR was associated with clinically modest declines in QoL among a large sample of community-dwelling older adults. This relationship varied by age, suggesting that a diminished eGFR contributes little to overall QoL beyond middle age in this population.
肾功能水平下降对老年人健康的影响尚不清楚。我们试图确定老年人中估计肾小球滤过率（eGFR）与总体生活质量（QoL）之间的关联。
对来自爱尔兰老龄化纵向研究的4293名参与者进行横断面分析，该研究是一项针对年龄≥50岁的社区居住成年人的基于人群的研究。我们使用多变量负二项回归模型来模拟胱抑素C估算肾小球滤过率（eGFR）或肌酐估算肾小球滤过率（eGFR）类别与老年人生活质量控制、自主、自我实现和愉悦（CASP-19）量表中生活质量缺陷数量之间的关系，该量表是老年人生活质量的综合衡量指标（范围为0至57）。我们进一步探讨了不同年龄层之间的这种关系。
中位年龄为61岁[四分位间距（IQR）55 - 68岁]，53%为女性，平均（标准差）CASP-19评分为44.8（7.4），中位eGFR为81（IQR 68 - 93）mL/min/1.73m²。多变量调整后，eGFR <45 mL/min/1.73m²的参与者与参照组（eGFR≥90 mL/min/1.73m²）相比，生活质量缺陷多14%{发病率比1.14（95%置信区间1.03 - 1.25）]。这种关系在各eGFR类别中呈线性，且在较年轻参与者（50 - 64岁）中比在年长参与者（65 - 74岁或≥75岁）中更明显。eGFR与CASP-19之间无实质性关系。
在大量社区居住的老年人样本中，胱抑素C估算肾小球滤过率而非肌酐估算肾小球滤过率与临床上适度的生活质量下降有关。这种关系因年龄而异，表明在该人群中，eGFR下降对中年以后的总体生活质量影响不大。
