Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Mathematical Institute, Medical Statistics Section, Department of Biomedical Data Science, Leiden University, Leiden University Medical Center, Leiden, the Netherlands.
JAMA Netw Open. 2020 Sep 1;3(9):e2017150. doi: 10.1001/jamanetworkopen.2020.17150.
With population aging, the burden of many age-related chronic conditions, including kidney failure, is increasing globally.
To investigate the risks of kidney failure and death in adults with incident stage IV chronic kidney disease (CKD).
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study obtained data recorded between July 30, 2002, and March 31, 2014, from the linked laboratory and administrative data set of Alberta Health in Alberta, Canada. All adults of the province of Alberta with stage IV CKD (estimated glomerular filtration rate [eGFR] of 15-30 mL/min/1.73 m2) were eligible for inclusion. Included individuals were followed up from study entry until the date of kidney failure, death, or censoring, whichever occurred first. Observations were censored at the date of emigration from the province, the study end date (March 31, 2017), or at 10 years after study entry. Data analyses were performed from January 2020 to June 2020.
The primary outcome was kidney failure, defined as the earlier of either renal replacement (dialysis or kidney transplant) initiation or severe kidney impairment (eGFR <10 mL/min/1.73 m2). Incidence of stage IV CKD in Alberta was examined over time, along with the association between age at study entry and the competing risks of kidney failure and death. Cumulative incidence functions (95% CIs) were estimated to summarize absolute risks over time across categories of age, accounting for sex, diabetes, cardiovascular disease, eGFR, and albuminuria.
The study included 30 801 adults (mean [SD] age, 76.8 [13.3] years; 17 294 women [56.1%]) with stage IV CKD. Of these, 5511 developed kidney failure (17.9%) and 16 285 died (52.9%). The incidence rate of stage IV CKD increased sharply with advancing age; the absolute risk of kidney failure decreased with advancing age, and the risk of death increased, especially in those aged 85 years or older. Compared with the 5-year risk of death, the 5-year risk of kidney failure was higher in people younger than 65 years, similar in people aged 65 to 74 years, and lower for older age groups. For those aged 75 years or older, the risk of death was much higher than the risk of kidney failure: 6-fold higher among those aged 75 to 84 years (0.51 [95% CI, 0.5-0.52] vs 0.09 [95% CI, 0.08-0.09]) and 25-fold higher among those aged 85 years or older (0.75 [95% CI, 0.74-0.76] vs 0.03 [95% CI, 0.02-0.03]). The risk of death was higher than the risk of kidney failure by 24-fold among those aged 85 to 94 years (0.73 [95% CI, 0.72-0.74] vs 0.03 [95% CI, 0.02-0.03]) and by 149-fold among those aged 95 years or older (0.89 [95% CI, 0.87-0.92] vs <0.01 [95% CI, <0.01 to 0.01]).
This study found that, although the incidence rate of stage IV CKD increased with advancing age, the absolute risk of kidney failure decreased. Unlike other age-related conditions, the expected increase in the burden of kidney failure in the older adults may be less dramatic than expected.
随着人口老龄化，全球范围内与年龄相关的许多慢性疾病（包括肾衰竭）的负担正在增加。
研究成人患有终末期慢性肾脏病（CKD）IV 期的肾衰竭和死亡风险。
设计、设置和参与者：这项基于人群的队列研究从加拿大阿尔伯塔省的阿尔伯塔省健康部门的实验室和行政数据集中获取了 2002 年 7 月 30 日至 2014 年 3 月 31 日之间记录的数据。该省所有患有 IV 期 CKD（肾小球滤过率[eGFR]为 15-30 毫升/分钟/1.73 平方米）的成年人都有资格入选。符合条件的个体从研究开始时开始随访，直到发生肾衰竭、死亡或首次出现随访截止日期。在该省移民、研究结束日期（2017 年 3 月 31 日）或研究开始后 10 年后，观察被截止。数据分析于 2020 年 1 月至 6 月进行。
主要结果是肾衰竭，定义为早期肾替代（透析或肾移植）开始或严重肾功能损害（eGFR <10 毫升/分钟/1.73 平方米）。研究了艾伯塔省 IV 期 CKD 的发病率随时间的变化，以及研究时的年龄与肾衰竭和死亡的竞争风险之间的关系。估计了累积发病率函数（95%CI），以总结随着时间的推移，在不同年龄组中绝对风险，考虑性别、糖尿病、心血管疾病、eGFR 和白蛋白尿。
该研究包括 30801 名患有 IV 期 CKD 的成年人（平均[标准差]年龄，76.8[13.3]岁；17294 名女性[56.1%]）。其中，5511 人发生肾衰竭（17.9%），16285 人死亡（52.9%）。IV 期 CKD 的发病率随着年龄的增长急剧上升；随着年龄的增长，肾衰竭的绝对风险降低，死亡风险增加，尤其是 85 岁以上的人群。与 5 年死亡风险相比，65 岁以下人群的 5 年肾衰竭风险较高，65 至 74 岁人群相似，而年龄较大的人群则较低。对于 75 岁或以上的人群，死亡风险远高于肾衰竭风险：75 至 84 岁人群的风险是 6 倍（0.51[95%CI，0.5-0.52]比 0.09[95%CI，0.08-0.09]），85 岁或以上人群的风险是 25 倍（0.75[95%CI，0.74-0.76]比 0.03[95%CI，0.02-0.03]）。85 至 94 岁人群的死亡风险比肾衰竭风险高 24 倍（0.73[95%CI，0.72-0.74]比 0.03[95%CI，0.02-0.03]），95 岁或以上人群的死亡风险比肾衰竭风险高 149 倍（0.89[95%CI，0.87-0.92]比 <0.01[95%CI，<0.01 至 0.01]）。
本研究发现，尽管 IV 期 CKD 的发病率随着年龄的增长而增加，但肾衰竭的绝对风险降低。与其他与年龄相关的疾病不同，老年人肾衰竭负担的预期增加可能不如预期那么显著。
