Toyama Tadashi, Kitagawa Kiyoki, Oshima Megumi, Kitajima Shinji, Hara Akinori, Iwata Yasunori, Sakai Norihiko, Shimizu Miho, Hashiba Atsushi, Furuichi Kengo, Wada Takashi
Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan.
Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan.
BMC Nephrol. 2020 Nov 13;21(1):477. doi: 10.1186/s12882-020-02121-z.
Annual decline in kidney function is a widely applied surrogate outcome of renal failure. It is important to understand the relationships between known risk factors and the annual decline in estimated glomerular filtration rate (eGFR) according to baseline age; however, these remain unclear.
A community-based retrospective cohort study of adults who underwent annual medical examinations between 1999 and 2013 was conducted. The participants were stratified into different age groups (40-49, 50-59, 60-69, 70-79, and ≥ 80 years) to assess the risk for loss of kidney function. A mixed-effects model was used to estimate the association between risk factors and annual changes in eGFR.
In total, 51,938 participants were included in the analysis. The age group of ≥80 years included 8127 individuals. The mean annual change in eGFR was - 0.39 (95% confidence interval: - 0.41 to - 0.37) mL/min/1.73 m per year. Older age was related to faster loss of kidney function. In the older age group, higher systolic blood pressure, proteinuria, and current smoking were related to faster loss of kidney function (p trend < 0.01, 0.03, and < 0.01, respectively). Conversely, each age group showed similar annual loss of kidney function related to lower hemoglobin levels and diabetes mellitus (p trend 0.47 and 0.17, respectively).
Higher systolic blood pressure, proteinuria, and smoking were related to faster loss of kidney function, and a greater effect size was observed in the older participants. More risk assessments for older people are required for personalized care.
肾功能的年度下降是肾衰竭广泛应用的替代结局。了解已知风险因素与根据基线年龄估计的肾小球滤过率（eGFR）年度下降之间的关系很重要；然而，这些关系仍不清楚。
对1999年至2013年间接受年度体检的成年人进行了一项基于社区的回顾性队列研究。参与者被分为不同年龄组（40 - 49岁、50 - 59岁、60 - 69岁、70 - 79岁和≥80岁）以评估肾功能丧失的风险。使用混合效应模型估计风险因素与eGFR年度变化之间的关联。
分析共纳入51938名参与者。≥80岁年龄组包括8127人。eGFR的平均年度变化为每年-0.39（95%置信区间：-0.41至-0.37）mL/min/1.73m²。年龄越大，肾功能丧失越快。在老年组中，较高的收缩压、蛋白尿和当前吸烟与肾功能丧失加快有关（p趋势分别<0.01、0.03和<0.01）。相反，各年龄组中，较低的血红蛋白水平和糖尿病与肾功能的年度丧失相似（p趋势分别为0.47和0.17）。
较高的收缩压、蛋白尿和吸烟与肾功能丧失加快有关，且在老年参与者中观察到更大的效应量。为了提供个性化护理，需要对老年人进行更多的风险评估。
