Service de Néphrologie-Dialyse, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France.
CESP, INSERM UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.
Nephrol Dial Transplant. 2020 May 1;35(5):827-836. doi: 10.1093/ndt/gfy277.
Although chronic kidney disease (CKD) and age are major risk factors for cardiovascular disease (CVD), little is known about the relative proportions of atheromatous and non-atheromatous CVD by age in CKD patients.
We used baseline data from the French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort of 3033 patients (65% men) with CKD Stages 3-4 to study crude and adjusted associations between age, the estimated glomerular filtration rate (eGFR), atheromatous CVD (coronary artery disease, peripheral artery disease and stroke) and non-atheromatous CVD (heart failure, cardiac arrhythmia and valvular heart disease).
Mean age was 66.8 and mean Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR was 32.9 mL/min/1.73 m2. In the <65, (65-74), (75-84) and ≥85 year age groups, the prevalence was, respectively, 18.7, 35.5, 42.9 and 37.8% for atheromatous CVD, and 14.9, 28.4, 38.1 and 56.4% for non-atheromatous CVD. After adjusting for albuminuria, sex and CVD risk factors, the odds ratio (OR) [95% confidence interval (CI)] for (65-74), (75-84) and ≥85 age groups (compared with the <65 group) was, respectively, 1.99 (1.61-2.46), 2.89 (2.30-3.62), 2.72 (1.77-4.18) for atheromatous CVD and 2.07 (1.66-2.58), 3.15 (2.50-3.97), 7.04 (4.67-10.61) for non-atheromatous CVD. Compared with patients with an eGFR ≥30 mL/min/1.73 m2, those with an eGFR <30 mL/min/1.73 m2 had a higher OR for atheromatous CVD [1.21 (1.01-1.44)] and non-atheromatous CVD [1.16 (0.97-1.38)].
In this large cohort of CKD patients, both atheromatous and non-atheromatous CVD were highly prevalent and more frequent in older patients. In a given age group, the prevalence of atheromatous and non-atheromatous CVD was similar (except for a greater prevalence of non-atheromatous CVD after 85).
虽然慢性肾脏病（CKD）和年龄是心血管疾病（CVD）的主要危险因素，但对于 CKD 患者中按年龄划分的动脉粥样硬化性和非动脉粥样硬化性 CVD 的相对比例知之甚少。
我们使用法国慢性肾脏病-肾脏流行病学和信息网络（CKD-REIN）队列的 3033 例 CKD 阶段 3-4 期患者（65%为男性）的基线数据，研究了年龄、估计肾小球滤过率（eGFR）、动脉粥样硬化性 CVD（冠状动脉疾病、外周动脉疾病和中风）与非动脉粥样硬化性 CVD（心力衰竭、心律失常和心脏瓣膜疾病）之间的粗关联和调整后关联。
平均年龄为 66.8 岁，慢性肾脏病流行病学合作组（CKD-EPI）eGFR 平均为 32.9ml/min/1.73m2。在<65、（65-74）、（75-84）和≥85 岁年龄组中，动脉粥样硬化性 CVD 的患病率分别为 18.7%、35.5%、42.9%和 37.8%，非动脉粥样硬化性 CVD 的患病率分别为 14.9%、28.4%、38.1%和 56.4%。在调整了白蛋白尿、性别和 CVD 危险因素后，（65-74）、（75-84）和≥85 岁年龄组与<65 岁年龄组相比，动脉粥样硬化性 CVD 的比值比（OR）[95%置信区间（CI）]分别为 1.99（1.61-2.46）、2.89（2.30-3.62）、2.72（1.77-4.18），而非动脉粥样硬化性 CVD 的 OR 分别为 2.07（1.66-2.58）、3.15（2.50-3.97）、7.04（4.67-10.61）。与 eGFR≥30ml/min/1.73m2 的患者相比，eGFR<30ml/min/1.73m2 的患者动脉粥样硬化性 CVD [1.21（1.01-1.44）]和非动脉粥样硬化性 CVD [1.16（0.97-1.38）]的 OR 更高。
在这项大型 CKD 患者队列研究中，动脉粥样硬化性和非动脉粥样硬化性 CVD 的患病率均很高，且在老年患者中更为常见。在特定年龄组中，动脉粥样硬化性和非动脉粥样硬化性 CVD 的患病率相似（85 岁后非动脉粥样硬化性 CVD 的患病率较高除外）。
