Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China.
National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Nephrol Dial Transplant. 2021 Dec 2;36(12):2274-2281. doi: 10.1093/ndt/gfaa323.
The diverse risk factors for kidney impairments suggest that kidney function decline is more likely to occur in individuals with a broadly constituted health deficit. Here we conducted a longitudinal cohort study to evaluate the association of baseline frailty status with the risk of estimated glomerular filtration rate (eGFR) decline.
Overall, 1269 participants aged 70-84 years from Rugao Longevity and Ageing cohort with 3-year follow-up were included. Frailty was measured using a modified Fried frailty assessment. GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. Associations between baseline frailty status and rapid eGFR decline were examined by multinomial logistic analysis. A linear mixed-effect model was used to determine eGFR decline in mL/min/1.73 m2 over the study period comparing those with frail or prefrail at baseline versus those with robust status.
The mean (± standard deviation) age of participants was 75.1 ± 3.8 years. A total of 144 (11%) participants had rapid eGFR decline by at least 10% during the 3-year follow-up. Compared with robust status, baseline frail status was associated with a 2.48-fold [95% confidence interval (CI) 1.24-4.95] increased risk of rapid eGFR decline after multiple adjustments. In multivariate linear mixed model analysis, subjects with frail status but not prefrail status at baseline had a significant coefficient of -1.70 (95% CI -3.35 to -0.04) for the frail × visit term, which indicates an accelerated eGFR decline compared with robust subjects over the study period (P = 0.044).
Frailty may serve as an independent biomarker to predict the decline of kidney function.
导致肾脏损伤的风险因素多种多样，这表明肾脏功能下降更有可能发生在健康状况普遍较差的个体中。在这里，我们进行了一项纵向队列研究，以评估基线虚弱状态与估算肾小球滤过率（eGFR）下降风险之间的关系。
共有 1269 名年龄在 70-84 岁的 Rugao 长寿与衰老队列参与者参加了这项研究，随访时间为 3 年。使用改良的 Fried 虚弱评估方法来评估虚弱状态。使用慢性肾脏病流行病学合作方程估算肾小球滤过率。通过多项逻辑回归分析来评估基线虚弱状态与 eGFR 快速下降之间的关系。使用线性混合效应模型来确定研究期间 mL/min/1.73 m2 的 eGFR 下降，比较基线时虚弱或衰弱前期与稳定状态的参与者。
参与者的平均（±标准差）年龄为 75.1 ± 3.8 岁。在 3 年的随访期间，共有 144 名（11%）参与者的 eGFR 快速下降至少 10%。与稳定状态相比，基线时的虚弱状态与快速 eGFR 下降的风险增加 2.48 倍（95%置信区间 [CI] 1.24-4.95），经多次调整后仍有统计学意义。在多变量线性混合模型分析中，基线时虚弱但非衰弱前期的受试者在虚弱×访视项的系数为-1.70（95%CI-3.35 至-0.04），这表明与稳定状态的受试者相比，在研究期间 eGFR 下降速度更快（P=0.044）。
虚弱状态可能是预测肾功能下降的独立生物标志物。
