Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,
Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Am J Nephrol. 2019;50(3):212-220. doi: 10.1159/000501539. Epub 2019 Jul 16.
Chronic kidney disease (CKD) risk staging is based on estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). However, the relationship between all-cause hospitalization risk and the current CKD staging system has not been well studied among older adults, despite a high prevalence of CKD and a high risk of hospitalization in old age.
Among 4,766 participants of the Atherosclerosis Risk in Communities study, CKD was staged according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, using creatinine-based eGFR (eGFRcr) and ACR. Incidence rates of all-cause hospitalization associated with each CKD risk group were analyzed using negative binomial regression. Additionally, cause-specific hospitalization risks for cardiovascular, infectious, kidney, and other diseases were estimated. The impacts of using cystatin C-based eGFR (eGFRcys) to estimate the prevalence of CKD and risks of hospitalization were also quantified.
Participants experienced 5,548 hospitalizations and 29% had CKD. Hospitalization rates per 1,000 person-years according to KDIGO risk categories were 208-223 ("low risk"), 288-376 ("moderately increased risk"), 363-548 ("high risk"), and 499-1083 ("very high risk"). The increased risk associated with low eGFR and high ACR persisted in adjusted analyses, examinations of cause-specific hospitalizations, and when CKD was staged by eGFRcys or eGFRcr-cys, a combined equation based on both creatinine and cystatin C. In comparison to eGFRcr, staging by eGFRcys increased the prevalence of CKD to 50%, but hospitalization risks remained similarly high.
DISCUSSION/CONCLUSION: In older adults, decreased eGFR, increased ACR, and KDIGO risk stages based on a combination of these measures, were strong risk factors for hospitalization. These relationships were consistent, regardless of the marker used to estimate GFR, but the use of cystatin C resulted in a substantially higher prevalence of CKD than the use of creatinine. Older adults in the population with very high risk stages of CKD have hospitalization rates exceeding 500 per 1,000 person-years.
慢性肾脏病（CKD）风险分期基于估算肾小球滤过率（eGFR）和白蛋白-肌酐比值（ACR）。然而，尽管老年人中 CKD 的患病率很高，住院风险也很高，但目前的 CKD 分期系统与全因住院风险之间的关系尚未得到很好的研究。
在社区动脉粥样硬化风险研究（Atherosclerosis Risk in Communities study）的 4766 名参与者中，根据肾脏病改善全球结果（KDIGO）标准，使用基于肌酐的 eGFR（eGFRcr）和 ACR 对 CKD 进行分期。使用负二项回归分析分析与每个 CKD 风险组相关的全因住院的发生率。此外，还估计了心血管、感染、肾脏和其他疾病的特定病因的住院风险。还量化了使用半胱氨酸蛋白酶抑制剂 C 基于 eGFR（eGFRcys）估计 CKD 患病率和住院风险的影响。
参与者经历了 5548 次住院治疗，其中 29%患有 CKD。根据 KDIGO 风险类别，每 1000 人年的住院率为 208-223（“低风险”）、288-376（“中度增加风险”）、363-548（“高风险”）和 499-1083（“极高风险”）。在调整分析、特定病因的住院治疗检查以及使用 eGFRcys 或 eGFRcr-cys 对 CKD 进行分期时，低 eGFR 和高 ACR 相关的风险增加仍然存在，这是基于肌酐和半胱氨酸蛋白酶抑制剂 C 的联合方程。与 eGFRcr 相比，基于 eGFRcys 的分期将 CKD 的患病率提高到 50%，但住院风险仍然很高。
讨论/结论：在老年人中，eGFR 降低、ACR 增加以及基于这些措施组合的 KDIGO 风险分期是住院的强烈危险因素。这些关系是一致的，无论用于估计 GFR 的标志物如何，但使用半胱氨酸蛋白酶抑制剂 C 会导致 CKD 的患病率显著高于使用肌酐。人群中 CKD 极高风险阶段的老年人的住院率超过每 1000 人年 500 人。
