LIM 16, Faculdade de Medicina da Universidade de São Paulo, Serviço de Nefrologia, Rua Dr. Enéas de Carvalho Aguiar 255, 7º Andar, São Paulo, SP, CEP, 05403-000, Brazil.
Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil.
Int Urol Nephrol. 2023 Dec;55(12):3245-3252. doi: 10.1007/s11255-023-03610-4. Epub 2023 May 9.
Despite CKD is common among older patients, and although factors associated with CKD progression have been explored over decades, little is known about the decline of renal function specifically in older individuals.
We included adult patients with CKD on conservative management in a propensity-score matched study 1:1 older (> 65 year) and young (≤ 65 yr). Factors associated with the slope of the decline of eGFR such as proteinuria, initial eGFR, diabetes, sex, and use of angiotensin-converting enzyme inhibitor/angiotensin receptor block (ACEI/ARB) were analyzed. Inclusion criteria were at least two consultations in the service and an initial eGFR lower than 45 ml/min/m, in the period between January 2012 and December 2017.
Crude analysis of eGFR decline shows a slower progression of older patients when compared to younger patients in both absolute change [- 2.0 (- 4.5, - 1.0) vs. -3.0 (- 7.0, - 1.0) ml/min/1.73m, p < 0.001] and slope of eGFR reduction [- 2.2 (- 4.4, - 1.0) vs. 3.1 (- 6.7, - 1.2)) ml/min/1.73m, p < 0.001]. Patients considered fast progressors (> 5 ml/min/1.73 m/year decline in eGFR) were less likely to be older (35.2% young vs. 22.0% older, p < 0.001). Adjusted logistic multivariate regression confirmed that older patients had less odds ratio of eGFR decline, independently of the presence of proteinuria, diabetes, ACEI/ARB use, sex, baseline eGFR, baseline phosphate and baseline 25(OH) vitamin D.
Older patients present slower CKD progression even after multiple adjustments. This information should be taken into consideration while treating these patients on conservative management and should be kept in mind while planning dialysis start.
尽管慢性肾脏病（CKD）在老年患者中较为常见，且数十年来人们一直在探索与 CKD 进展相关的因素，但对于老年人肾功能下降的具体情况知之甚少。
我们纳入了接受保守治疗的 CKD 成年患者，并进行了倾向评分匹配的 1:1 老年（>65 岁）和年轻（≤65 岁）患者的研究。分析了蛋白尿、初始 eGFR、糖尿病、性别和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）的使用等与 eGFR 下降斜率相关的因素。纳入标准为在 2012 年 1 月至 2017 年 12 月期间，在该服务部门至少就诊两次，且初始 eGFR 低于 45ml/min/1.73m。
与年轻患者相比，老年患者的 eGFR 下降幅度在绝对值[−2.0（−4.5，−1.0）与−3.0（−7.0，−1.0）ml/min/1.73m，p<0.001]和 eGFR 下降斜率[−2.2（−4.4，−1.0）与 3.1（−6.7，−1.2）ml/min/1.73m，p<0.001]方面均较慢。被认为是快速进展者（eGFR 下降>5ml/min/1.73m/年）的患者中，老年患者的比例较低（35.2%年轻患者比 22.0%老年患者，p<0.001）。调整后的多变量逻辑回归证实，在考虑蛋白尿、糖尿病、ACEI/ARB 使用率、性别、基线 eGFR、基线磷酸盐和基线 25（OH）维生素 D 等因素后，老年患者的 eGFR 下降比值比更小。
即使进行了多次调整，老年患者的 CKD 进展仍然较慢。在对这些患者进行保守治疗时应考虑到这一点，在计划开始透析时也应牢记这一点。
