Department of Geriatrics, Skåne University Hospital, Jan Waldenströms gata 35, 20502, Malmö, Sweden.
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Aging Clin Exp Res. 2019 Oct;31(10):1461-1469. doi: 10.1007/s40520-018-1091-x. Epub 2018 Dec 17.
The prevailing diagnostic criteria for CKD are age-independent, but have been challenged in light of the eGFR decline associated with normal aging. The stages of CKD communicate magnitude of risk of ESRD, cardiovascular morbidity, and mortality.
This study aims to provide more insight into the morbidity and mortality associated with eGFR levels corresponding to the current CKD stages in older adults.
The 2931 older adults in the Good Aging in Skåne study were randomized from the general population. The exposure variable used was eGFR level (CKD-EPI based on creatinine and cystatin C) with eGFR 60-89 mL/min/1.73 m as a reference; the outcomes were mortality, acute cardiovascular disease, congestive heart failure, and rapid kidney function decline (RKFD; defined as a decline in eGFR by 3 mL/min/1.73 m per year or more).
The mean age at baseline was 73 (SD 11) and mean follow-up time 11 (SD 5) years. Mortality was higher at lower eGFR levels with adjusted HR (95% CI) being 1.58 (1.34-1.88), 1.22 (1.05-1.41), 1 (reference), and 0.90 (0.67-1.21) for eGFR < 45, 45-59, 60-89 and ≥ 90 mL/min/1.73 m, respectively. For acute CVD the adjusted HR (95% CI) were 1.23 (0.81-1.87), 1.21 (0.87-1.69), 1 (reference), and 0.53 (0.28-1.00) for the same eGFR levels.
This study confirms that mortality in older adults increases with decreasing eGFR at eGFR levels below today's threshold for CKD. The correlation was less certain for lower eGFR and incident cardiovascular disease.
目前用于 CKD 的诊断标准与年龄无关，但鉴于与正常衰老相关的 eGFR 下降，这些标准受到了挑战。CKD 的各个阶段反映了发生 ESRD、心血管疾病发病率和死亡率的风险程度。
本研究旨在更深入地了解与老年人中当前 CKD 阶段相对应的 eGFR 水平相关的发病率和死亡率。
在斯科讷健康老龄化研究中，2931 名年龄较大的成年人从一般人群中被随机抽取。所使用的暴露变量是 eGFR 水平（基于肌酐和胱抑素 C 的 CKD-EPI），以 eGFR 60-89 mL/min/1.73 m 作为参考；结局是死亡率、急性心血管疾病、充血性心力衰竭和肾功能快速下降（定义为 eGFR 每年下降 3 mL/min/1.73 m 或更多）。
基线时的平均年龄为 73（SD 11）岁，平均随访时间为 11（SD 5）年。死亡率随着 eGFR 水平的降低而升高，调整后的 HR（95%CI）分别为 1.58（1.34-1.88）、1.22（1.05-1.41）、1（参考）和 0.90（0.67-1.21），用于 eGFR<45、45-59、60-89 和≥90 mL/min/1.73 m。对于急性 CVD，调整后的 HR（95%CI）分别为 1.23（0.81-1.87）、1.21（0.87-1.69）、1（参考）和 0.53（0.28-1.00），用于相同的 eGFR 水平。
本研究证实，在 eGFR 低于目前 CKD 阈值的水平下，老年人的死亡率随着 eGFR 的降低而增加。对于较低的 eGFR 和发生心血管疾病，相关性不太确定。
