Katz-Agranov Nurit, Rieu-Werden Meghan L, Thacker Ayush, Lykken Jacquelyn M, Sise Meghan E, Shah Sachin J
Renal Division, Department of Medicine, VA Boston Healthcare System, Boston, MA.
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.
Clin J Am Soc Nephrol. 2024 Oct 1;19(10):1275-1283. doi: 10.2215/CJN.0000000000000523. Epub 2024 Aug 15.
A large eGFR discordance (., cystatin C–based eGFR >30% lower than creatinine-based eGFR) is common in older adults and increased with age. A large eGFR discordance was associated with increased risk of falls, hospitalization, and death, independent of kidney function. There are multiple ways to measure differences in creatinine and cystatin C; all produce similar associations with aging-related adverse outcomes.
eGFR calculated using creatinine and cystatin C often differ in older adults. We hypothesized that older adults with cystatin C–based eGFR (eGFRcys) values significantly lower than creatinine-based eGFR (eGFRcr) values may have higher risk of aging-related adverse outcomes, independent of kidney function.
We conducted a longitudinal cohort study of adults 65 years and older from the Health and Retirement Study, a cohort of older American adults, to determine the relationship between eGFR discordance and aging-related adverse outcomes. We calculated eGFRcr and eGFRcys using baseline creatinine and cystatin C measurements. A large eGFR discordance was defined as eGFRcys >30% lower than eGFRcr. We assessed four aging-related adverse outcomes over a 2-year follow-up: falls, hip fractures, hospitalizations, and death. We fit separate multivariable regression models to determine the association between having a large eGFR discordance and each outcome adjusting for confounders, including kidney function.
Of 5574 older adults, 1683 (30%) had a large eGFR discordance. Those with a large eGFR discordance were more likely to be older, female, and White. The prevalence of a large eGFR discordance increased with age, from 20% among those 65–69 years to 44% among those 80 years and older. Over a 2-year follow-up, there were 305 deaths (5.5%), 2013 falls (39.2%), 69 hip fractures (1.3%), and 1649 hospitalizations (32.2%). In adjusted analyses, large eGFR discordance was associated with a higher hazard ratio for death (hazard ratio, 1.43; 95% confidence interval [CI], 1.12 to 1.82) and significantly higher odds of falls (odds ratio, 1.32; 95% CI, 1.16 to 1.51) and hospitalizations (odds ratio, 1.32; 95% CI, 1.15 to 1.51). A large eGFR discordance was not associated with hip fractures.
In a large, nationally representative cohort of older adults, prevalence of eGFR discordance increased with age and was associated with higher risk of falls, hospitalization, and death, independent of kidney function.
估算肾小球滤过率（eGFR）的显著差异（即基于胱抑素C的eGFR比基于肌酐的eGFR低30%以上）在老年人中很常见，且随年龄增长而增加。eGFR的显著差异与跌倒、住院和死亡风险增加相关，且与肾功能无关。有多种方法可测量肌酐和胱抑素C的差异；所有方法与衰老相关不良结局的关联相似。
在老年人中，使用肌酐和胱抑素C计算的eGFR通常存在差异。我们假设，基于胱抑素C的eGFR（eGFRcys）值显著低于基于肌酐的eGFR（eGFRcr）值的老年人，可能有更高的衰老相关不良结局风险，且与肾功能无关。
我们对来自美国老年人队列“健康与退休研究”中65岁及以上的成年人进行了一项纵向队列研究，以确定eGFR差异与衰老相关不良结局之间的关系。我们使用基线肌酐和胱抑素C测量值计算eGFRcr和eGFRcys。eGFR的显著差异定义为eGFRcys比eGFRcr低30%以上。在2年的随访中，我们评估了四种与衰老相关的不良结局：跌倒、髋部骨折、住院和死亡。我们拟合了单独的多变量回归模型，以确定存在eGFR显著差异与每种结局之间的关联，并对包括肾功能在内的混杂因素进行了校正。
在5574名老年人中，1683人（30%）存在eGFR的显著差异。存在eGFR显著差异的人更可能年龄较大、为女性且为白人。eGFR显著差异的患病率随年龄增长而增加，从65 - 69岁人群中的20%增至80岁及以上人群中的44%。在2年的随访中，有305人死亡（5.5%），2013人跌倒（39.2%），69人髋部骨折（1.3%），1649人住院（32.2%）。在多因素分析中，eGFR的显著差异与死亡风险比升高相关（风险比为1.43；95%置信区间[CI]为1.12至1.82），跌倒（优势比为1.32；95% CI为1.16至1.51）和住院（优势比为1.32；95% CI为1.15至1.51）的几率显著更高。eGFR的显著差异与髋部骨折无关。
在一个具有全国代表性的大型老年人群队列中，eGFR差异的患病率随年龄增长而增加，且与跌倒、住院和死亡风险升高相关，与肾功能无关。
