慢性肾脏病老年患者认知衰弱的患病率及相关因素：一项横断面研究。
Prevalence and associated factors of cognitive frailty in older patients with chronic kidney disease: a cross-sectional study.
机构信息
Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Gong-Ti South Road 8#, Chao-Yang District, Beijing, 100020, China.
Department of Nephrology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
出版信息
BMC Geriatr. 2022 Aug 17;22(1):681. doi: 10.1186/s12877-022-03366-z.
BACKGROUND
Chronic kidney disease (CKD) is prevalent in older adults. In the aging CKD population, cognitive frailty is more common, but its prevalence and associated risk factors need to be further investigated.
METHODS
This is a cross-sectional study that enrolled patients aged ≥ 60 years with a diagnosis of CKD from January 2018 to February 2021. Patients were assessed for frailty and cognition with the FRAIL and the Mini-Mental State Examination (MMSE) scales and were divided into the cognitive frailty and non-cognitive frailty groups. Risk factors for cognitive frailty were identified by univariate and multivariate logistic regression analyses. A prediction model for cognitive frailty was built and a nomogram was plotted. The performance of the nomogram was evaluated by using a concordance index (C-index) and calibration plots.
RESULTS
A total of 1015 older patients with CKD were enrolled, among whom 607 (59.8%) were males and 408 (40.2%) were females, with an age ranging from 60 to 98 years, and an cognitive frailty prevalence of 15.2%. The prevalence of cognitive frailty varied among the CKD stages 1-5, with rates of 4.7%, 7.5%, 13.8%, 18.5%, and 21.4%, respectively. Multivariate logistic regression analysis showed that age (OR = 1.11, 95%CI 1.08-1.14, p < 0.001), depression (OR = 2.52, 95%CI 1.54-4.11, p < 0.001), low social support (OR = 2.08, 95%CI 1.28-3.39, p = 0.003), Charlson comorbidity index (CCI) (OR = 1.92, 95%CI 1.70-2.18, p < 0.001), eGFR (OR = 0.98, 95%CI 0.96-0.99, p < 0.001) and albuminuria (OR = 5.93, 95%CI 3.28-10.74, p < 0.001) were independent risk factors affecting the association with cognitive frailty in older patients with CKD. A nomogram for assessing cognitive frailty was established and well-calibrated with a C-index of 0.91 (95%CI 0.89-0.94).
CONCLUSIONS
The prevalence of cognitive frailty was higher in older patients having CKD. Advanced age, comorbidity, depression, low social support, eGFR and albuminuria were independent risk factors for CKD accompanied with cognitive frailty.
背景
慢性肾脏病（CKD）在老年人中较为普遍。在老龄化的 CKD 人群中，认知脆弱更为常见，但需要进一步研究其患病率和相关危险因素。
方法
这是一项横断面研究，纳入了 2018 年 1 月至 2021 年 2 月期间年龄≥60 岁、诊断为 CKD 的患者。使用 FRAIL 和简易精神状态检查（MMSE）量表评估患者的脆弱性和认知功能，并将其分为认知脆弱和非认知脆弱组。采用单因素和多因素逻辑回归分析确定认知脆弱的危险因素。建立认知脆弱的预测模型并绘制诺模图。使用一致性指数（C 指数）和校准图评估诺模图的性能。
结果
共纳入 1015 名患有 CKD 的老年患者，其中 607 名（59.8%）为男性，408 名（40.2%）为女性，年龄 60-98 岁，认知脆弱患病率为 15.2%。CKD 1-5 期的认知脆弱患病率不同，分别为 4.7%、7.5%、13.8%、18.5%和 21.4%。多因素逻辑回归分析显示，年龄（OR=1.11，95%CI 1.08-1.14，p<0.001）、抑郁（OR=2.52，95%CI 1.54-4.11，p<0.001）、低社会支持（OR=2.08，95%CI 1.28-3.39，p=0.003）、Charlson 合并症指数（CCI）（OR=1.92，95%CI 1.70-2.18，p<0.001）、eGFR（OR=0.98，95%CI 0.96-0.99，p<0.001）和白蛋白尿（OR=5.93，95%CI 3.28-10.74，p<0.001）是影响 CKD 老年患者认知脆弱的独立危险因素。建立了一个用于评估认知脆弱的诺模图，具有 0.91（95%CI 0.89-0.94）的良好校准 C 指数。
结论
患有 CKD 的老年患者认知脆弱的患病率较高。高龄、合并症、抑郁、低社会支持、eGFR 和白蛋白尿是 CKD 合并认知脆弱的独立危险因素。
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