Flaherty Carina M, Surapaneni Aditya, Seegmiller Jesse C, Coresh Josef, Grams Morgan E, Ballew Shoshana H
Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY.
Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN.
Kidney Med. 2024 Aug 14;6(10):100893. doi: 10.1016/j.xkme.2024.100893. eCollection 2024 Oct.
RATIONALE & OBJECTIVE: The prevalence of chronic kidney disease (CKD) is known to increase with age; however, creatinine may be a less reliable filtration marker in older adults. Few studies have investigated the prevalence and progression of CKD using different filtration markers for estimating glomerular filtration rate (GFR).
A prospective observational cohort study.
SETTING & PARTICIPANTS: 6,393 White and African American participants aged 65-100 years from the Atherosclerosis Risk in Communities Study (ARIC) at Visit 5, followed longitudinally at Visits 6 and 7.
The eGFR was estimated either by creatinine (eGFRcr), cystatin C (eGFRcys), creatinine and cystatin C (eGFRcr-cys), or using creatinine, cystatin C, and β-2-microglobulin (eGFRcr-cys-b2m). CKD progression was defined as 30% decline in eGFR at follow-up visits.
Logistic regression models, adjusted for sex, race and study center, diabetes, blood pressure, body mass index, prevalent cardiovascular disease, and heart failure.
At Visit 5, the mean age in the study population was 75.8 years, and the mean eGFR ranged from 71.2 to 61.2 mL/min/1.73m using eGFRcr or eGFRcys, respectively. The proportion with eGFR < 60 mL/min/1.73m was lowest with eGFRcr and highest with eGFRcys for all age groups, and prevalence increased with age for all markers. For example, the prevalence of eGFRcr < 60 mL/min/1.73m in ages 70-74 years ranged from 15% to 21% and in ages 85-89 years ranged from 38% to 46% at the different visits. The proportion with a 30% eGFR decline over a mean of 8 years in people who were originally aged 65-69 years ranged from 9% (eGFRcr)-18% (eGFRcys). More people with eGFRcr ≥ 60 mL/min/1.73m were reclassified to < 60 mL/min/1.73m when using eGFRcys (33%) compared with eGFRcr-cys (12%) or eGFRcr-cys-b2m (18%). The proportion with 30% eGFR decline was lowest with eGFRcr and highest with eGFRcys, with greater incidence in older age groups for all markers.
No direct measurement of GFR. Not all participants survived or attended subsequent follow-up visits.
The prevalence and progression of CKD increase with age, but estimates vary with the filtration marker used. The eGFRcr gave the lowest estimate of CKD at 15% for people aged 65-69 years at Visit 5 while eGFRcys gave the highest estimates of CKD at 26% for that same population.
已知慢性肾脏病（CKD）的患病率随年龄增长而增加；然而，肌酐在老年人中可能是一个不太可靠的滤过标志物。很少有研究使用不同的滤过标志物来估计肾小球滤过率（GFR），进而调查CKD的患病率和进展情况。
一项前瞻性观察队列研究。
来自社区动脉粥样硬化风险研究（ARIC）的6393名65至100岁的白人和非裔美国参与者，在第5次访视时参与研究，并在第6次和第7次访视时进行纵向随访。
采用肌酐（eGFRcr）、胱抑素C（eGFRcys）、肌酐和胱抑素C（eGFRcr-cys）或肌酐、胱抑素C和β2微球蛋白（eGFRcr-cys-b2m）来估算估算肾小球滤过率（eGFR）。CKD进展定义为随访时eGFR下降30%。
采用逻辑回归模型，对性别、种族、研究中心、糖尿病、血压、体重指数、既往心血管疾病和心力衰竭进行校正。
在第5次访视时，研究人群的平均年龄为75.8岁，使用eGFRcr或eGFRcys时，平均eGFR分别为71.2至61.2 mL/min/1.73m²。所有年龄组中，eGFR＜60 mL/min/1.73m²的比例以eGFRcr最低，以eGFRcys最高，且所有标志物的患病率均随年龄增加。例如，在不同访视中，70至74岁年龄组中eGFRcr＜60 mL/min/1.73m²的患病率为15%至21%，85至89岁年龄组中为38%至46%。最初年龄在65至69岁的人群中（平均随访8年），eGFR下降30%的比例为9%（eGFRcr）至18%（eGFRcys）。与eGFRcr-cys（12%）或eGFRcr-cys-b2m（18%）相比，使用eGFRcys时，更多eGFRcr≥60 mL/min/1.73m²的人被重新分类为eGFR＜60 mL/min/1.73m²（33%）。各标志物中，eGFR下降30%的比例以eGFRcr最低，以eGFRcys最高，且所有标志物在老年组中的发病率更高。
未直接测量GFR。并非所有参与者都存活或参加了后续随访。
CKD的患病率和进展随年龄增加，但估算结果因所用的滤过标志物而异。在第5次访视时，对于65至69岁的人群，eGFRcr对CKD的估算最低，为15%，而eGFRcys对CKD的估算最高，为26%。
