Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Service de Gériatrie, CHU de Caen, Normandie Université UNICAEN, Caen, France.
Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France.
J Am Med Dir Assoc. 2022 Jun;23(6):998-1004.e7. doi: 10.1016/j.jamda.2021.10.019. Epub 2021 Nov 29.
Renin-angiotensin system inhibitors (RASi) are recommended for slowing chronic kidney disease (CKD) progression to kidney failure. Their effectiveness and tolerance as patients age remain uncertain because older patients have often been excluded from clinical trials.
CKD-REIN cohort study.
We studied 2762 patients with CKD stages 3 and 4 and a clinical indication for RASi enrolled between 2013 and 2016 in 40 nephrology clinics nationally representative in France.
The primary outcome was the occurrence of kidney failure or death. The secondary outcomes were the occurrence of cardiovascular events and hospitalizations with acute kidney injury (AKI) or hyperkalemia. A propensity score analysis was performed. We used Cox models to estimate hazard ratios (HRs) for each outcome associated with RASi prescription and tested interactions with age.
Patients' mean age was 67 years, including 841 (30%) aged 75 years and older; 2178 (79%) were prescribed RASi's. During a median follow-up of 4.6 years, 33% of patients reached kidney failure or died. RASi prescription was associated with a lower risk of kidney failure or death (HR 0.79, 95% CI 0.66, 0.95), an association not modified by age (P for interaction = .72). It was not significantly associated with cardiovascular events. During the first 3 years of follow-up, 14% of patients were hospitalized with AKI or hyperkalemia, but risk was not higher among those prescribed RASi's (HR 0.75, 95% CI 0.55-1.02) and age did not modify its effect (P for interaction = .28).
This study shows that aging does not appear to modify either RASi's beneficial effects on major CKD outcomes or their potential adverse effects.
肾素-血管紧张素系统抑制剂（RASi）被推荐用于减缓慢性肾脏病（CKD）向肾衰竭的进展。然而，随着患者年龄的增长，其有效性和耐受性仍然不确定，因为老年患者通常被排除在临床试验之外。
CKD-REIN 队列研究。
我们研究了 2013 年至 2016 年间在法国全国范围内具有代表性的 40 个肾病诊所中登记的 2762 名患有 CKD 3 期和 4 期且有 RASi 临床适应证的患者。
主要结局是发生肾衰竭或死亡。次要结局是发生心血管事件以及因急性肾损伤（AKI）或高钾血症住院。进行了倾向评分分析。我们使用 Cox 模型估计与 RASi 处方相关的每个结局的风险比（HR），并测试了与年龄的交互作用。
患者的平均年龄为 67 岁，包括 841 名（30%）年龄在 75 岁及以上；2178 名（79%）患者处方了 RASi。在中位随访 4.6 年后，33%的患者发生肾衰竭或死亡。RASi 处方与较低的肾衰竭或死亡风险相关（HR 0.79，95%CI 0.66，0.95），这种关联不受年龄的影响（交互作用 P=0.72）。它与心血管事件无显著关联。在随访的前 3 年内，14%的患者因 AKI 或高钾血症住院，但接受 RASi 治疗的患者风险并未增加（HR 0.75，95%CI 0.55-1.02），且年龄并未改变其效果（交互作用 P=0.28）。
本研究表明，年龄似乎既不会改变 RASi 对主要 CKD 结局的有益作用，也不会改变其潜在的不良作用。
