Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
PLoS One. 2019 Jul 23;14(7):e0219956. doi: 10.1371/journal.pone.0219956. eCollection 2019.
Chronic Kidney Disease (CKD) is a worldwide public health problem. The prevalence of CKD is rising especially in elderly, as consequence of population-ageing related to socioeconomic development and better life expectancy. There are scarce studies evaluating CKD progression and its associated factors in elderly patients.
This is a retrospective observational study including 340 patients (≥ 65 years old) CKD stages 3a-5 non-dialysis, incidents in an outpatient CKD clinic, followed by 2.1 years. CKD progression was assessed by the slope of eGFR calculated by CKD-EPI and BIS 1 equations. The patients were divided in progressor and non-progressor groups (eGFR slope < or ≥ 0 mL/min/1.73 m2/year, respectively).
Kidney function declined in 193 (57%) patients. In this group, the progression rate was -2.83 (-5.1 / -1.1) mL /min /1.73 m2 /year. Compared to non progressor, the progressor patients were younger [72 (69-78) vs. 76 (69-80) years; p = 0.02]; had higher proportion of diabetic nephropathy, higher serum phosphorus [3.8 (3.3-4.1) vs. 3.5 (3.9-4.1) mg/dL; p = 0.04] and proteinuria [0.10 (0-0.9 vs. 0 (0-0.3)] g/L; p = 0.007)] at the admission. In the logistic regression analysis adjusted for gender and eGFR, proteinuria was independently associated with CKD progression [OR (Odds Ratio) (1.83; 95% CI, 1.17-2.86; p < 0.01)].
CKD progression was observed in the majority of elderly CKD patients and proteinuria was the most important factor associated to the decline of kidney function in this population.
慢性肾脏病（CKD）是一个全球性的公共卫生问题。CKD 的患病率呈上升趋势，尤其是在老年人中，这是由于人口老龄化与社会经济发展和预期寿命延长有关。目前，评估老年人 CKD 进展及其相关因素的研究较少。
这是一项回顾性观察性研究，纳入了 340 名（≥65 岁）非透析的 CKD3a-5 期门诊患者，随访时间为 2.1 年。CKD 进展通过 CKD-EPI 和 BIS1 方程计算的 eGFR 斜率来评估。将患者分为进展组和非进展组（eGFR 斜率分别<0mL/min/1.73m2/年和≥0mL/min/1.73m2/年）。
193 名（57%）患者的肾功能下降。在这组患者中，进展速度为-2.83（-5.1/ -1.1）mL/min/1.73m2/年。与非进展组相比，进展组患者更年轻[72（69-78）岁 vs. 76（69-80）岁；p=0.02]；糖尿病肾病比例更高，血清磷[3.8（3.3-4.1）mg/dL vs. 3.5（3.9-4.1）mg/dL；p=0.04]和蛋白尿[0.10（0-0.9）g/L vs. 0（0-0.3）g/L；p=0.007]更高。在校正性别和 eGFR 后，多因素 logistic 回归分析显示，蛋白尿与 CKD 进展独立相关[比值比（OR）（1.83；95%置信区间，1.17-2.86；p<0.01)]。
大多数老年 CKD 患者的 CKD 均有进展，蛋白尿是该人群肾功能下降的最重要相关因素。
