Kidney Unit, National Hospital Organization, Fukuokahigashi Medical Center, Fukuoka, Japan.
Division of Nephrology, Medical Corporation Houshikai, Kano Hospital, Fukuoka, Japan.
Nephrology (Carlton). 2023 Jun;28(6):336-344. doi: 10.1111/nep.14163. Epub 2023 Apr 22.
Although the number of elderly patients with chronic kidney disease (CKD) has increased, few studies have examined their prognosis.
The study design was a retrospective cohort study at a single centre. We evaluated 301 patients aged ≥75 years old with CKD stage G3a to G5. The primary endpoint was kidney failure with replacement therapy (KFRT) and secondary endpoints were all-cause mortality and annual decline rates of estimated glomerular filtration rate (eGFR). The incidence of KFRT was estimated using the cumulative incidence method considering the competing risk of death. To identify the independent risk factors related to KFRT, multivariate Fine-Gray regression model analysis were performed.
The median age of the patients was 79 years and the median eGFR was 24.0 mL/min/1.73 m at baseline. Urinary protein was positive in 70% of patients. With a median follow-up of 24.5 months, 35% of the patients developed KFRT and 9% died. Kidney survival significantly decreased according to the CKD stage at baseline. In patients without proteinuria, the cumulative incidence of KFRT increased in CKD stage G5 patients, while in patients with proteinuria, the incidence of KFRT increased from patients with CKD stage G3b. Multivariate Fine-Gray regression model revealed that less aged, CKD stage G5, baseline data such as proteinuria, hypoalbuminemia, hyperphosphatemia, and hyperuricemia were independent risk factors for KFRT.
Elderly CKD patients with proteinuria need to be carefully monitored even at an early CKD stage because of the risk of developing KFRT.
尽管患有慢性肾脏病（CKD）的老年患者人数有所增加，但很少有研究探讨他们的预后。
本研究设计为单中心回顾性队列研究。我们评估了 301 名年龄≥75 岁的 CKD G3a 至 G5 期患者。主要终点是需要肾脏替代治疗的肾衰竭（KFRT），次要终点是全因死亡率和估算肾小球滤过率（eGFR）的年下降率。考虑到死亡的竞争风险，使用累积发生率法估计 KFRT 的发生率。为了确定与 KFRT 相关的独立危险因素，进行了多变量 Fine-Gray 回归模型分析。
患者的中位年龄为 79 岁，基线时的中位 eGFR 为 24.0 mL/min/1.73 m2。70%的患者尿蛋白阳性。中位随访 24.5 个月后，35%的患者发生 KFRT，9%的患者死亡。根据基线时的 CKD 分期，肾脏生存率显著下降。在无蛋白尿的患者中，CKD 分期 G5 患者的 KFRT 累积发生率增加，而在蛋白尿患者中，CKD 分期 G3b 患者的 KFRT 发生率增加。多变量 Fine-Gray 回归模型显示，年龄较小、CKD 分期 G5、基线时的蛋白尿、低白蛋白血症、高磷血症和高尿酸血症等数据是 KFRT 的独立危险因素。
即使在早期 CKD 阶段，有蛋白尿的老年 CKD 患者也需要密切监测，因为他们有发生 KFRT 的风险。
