Nephrology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
"Dr. Carol Davila" Teaching Hospital of Nephrology, 4 Calea Grivitei, sect. 1, Bucharest, Romania.
J Nephrol. 2022 Dec;35(9):2301-2312. doi: 10.1007/s40620-022-01427-5. Epub 2022 Sep 9.
The use of kidney biopsy in elderly individuals is still matter of discussion. The purpose of this study is to assess the utility of kidney biopsy for the management of glomerulopathies in an Eastern European cohort, targeting patients older than 65 years.
This retrospective study included 875 adults (147 older than 65 years), with biopsy-proven glomerulopathies, followed up for 71.1 (95% CI 68.2-73.9) months. The primary endpoint was chronic renal replacement therapy initiation. Statistical evaluation was performed with IBM SPSS software version 20, Analyse-it, and SAS Studio. The Kaplan-Meier method was used to estimate the time to death and the log-rank test was used for comparisons. The multivariate Cox proportional hazard analysis was used to evaluate the risk of death.
Secondary glomerulopathies were more frequent in patients aged > 65 years (52.4% vs. 41.9%, p = 0.004). Membranous nephropathy and amyloidosis were the most frequent primary and secondary glomerulopathies in this age group. Kidney biopsy complications were low (< 4%) in both age groups. In 42% of the elderly, the result of biopsy guided the immunosuppressive therapy. While the all-cause mortality rate was higher (OR 4.2; 95% CI 2.7-6.7; p < 0.0001) in elderly individuals, the rate of renal replacement therapy initiation was similar (31.3 vs 26%; p = 0.1) in both age groups. In the competitive risk analysis, kidney survival was similar irrespective of age [CIF 0.4 (95% CI 0.26-0.53) vs. 0.34 (95% CI 0.28-0.39), p = 0.08]. However, after adjusting for the confounding factors, younger age was associated with an increased risk of renal replacement therapy (HR = 1.57, p = 0.01), along with secondary glomerulopathies.
The diagnosis of an underlying glomerulopathy guided the therapy in almost one-half of the elderly patients who underwent a kidney biopsy, provided important prognostic information and had a low complications rate; kidney biopsy may therefore be considered a safe, reliable procedure in the management of glomerulopathies, even in patients over 65 years of age.
在老年人中使用肾活检仍然存在争议。本研究的目的是评估肾活检在东欧队列中对肾小球疾病管理的实用性，目标人群为年龄大于 65 岁的患者。
这是一项回顾性研究，纳入了 875 例经活检证实的肾小球疾病患者（147 例年龄大于 65 岁），随访时间为 71.1 个月（95%CI 68.2-73.9）。主要终点是开始慢性肾脏替代治疗。使用 IBM SPSS 软件版本 20、Analyse-it 和 SAS Studio 进行统计评估。使用 Kaplan-Meier 法估计死亡时间，并使用对数秩检验进行比较。使用多变量 Cox 比例风险分析评估死亡风险。
年龄大于 65 岁的患者中继发性肾小球疾病更为常见（52.4% vs. 41.9%，p=0.004）。膜性肾病和淀粉样变性是该年龄组中最常见的原发性和继发性肾小球疾病。两组肾活检并发症发生率均较低（<4%）。在 42%的老年人中，活检结果指导了免疫抑制治疗。虽然老年人的全因死亡率较高（OR 4.2；95%CI 2.7-6.7；p<0.0001），但两组的肾脏替代治疗起始率相似（31.3% vs. 26%；p=0.1）。在竞争风险分析中，无论年龄大小，肾脏存活率相似[CIF 0.4（95%CI 0.26-0.53）vs. 0.34（95%CI 0.28-0.39），p=0.08]。然而，在校正混杂因素后，年龄较小与肾脏替代治疗风险增加相关（HR=1.57，p=0.01），同时也与继发性肾小球疾病相关。
在接受肾活检的老年患者中，近一半患者的肾小球疾病诊断指导了治疗，提供了重要的预后信息，且并发症发生率较低；因此，肾活检可能是一种安全、可靠的肾小球疾病管理方法，即使在年龄大于 65 岁的患者中也是如此。
