Zhang Fan, Zhao Yuanjing, Bai Yan, Huang Liuyan, Li Jiao, Zhong Yifei
Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Oncology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Clin Nutr ESPEN. 2025 Jul 26;69:375-383. doi: 10.1016/j.clnesp.2025.07.1112.
This cross-sectional study aims to investigate the difference in estimated glomerular filtration rate (eGFR) based on cystatin c and creatinine and risk of frailty among elderly individuals and to explore the mediating role of high-sensitivity C-reactive protein (hs-CRP).
eGFR was calculated using both absolute difference (eGFR) and ratio (eGFR) between cystatin C- and creatinine-based calculations. Frailty status was assessed by the frailty index ranging from 0 to 100 and frailty was defined as ≥ 25. We employed logistic regression models to examine the association between different eGFR measures and frailty risk, adjusting for sociodemographic factors, lifestyle, and health status. Restricted cubic spline for fitting the nonlinear association between eGFR and frailty status. The mediating role of hs-CRP was explored using mediation analysis.
Our analysis included 4989 participants with a median age of 66 years. Approximately 25 % of participants were identified with a frailty condition. In the fully adjusted model, each 15-unit higher eGFR was associated with 17.0 % lower odds of prevalent frailty (odds ratio [OR] = 0.830; 95 % confidence interval [95 % CI]: 0.768, 0.897), for each 10 % increase in eGFR, the corresponding OR was 0.383 (95 % CI: 0.267, 0.549). Compared with participants with similar eGFR (i.e., -15< eGFR <15 mL/min/1.73 m), participants in the negative group (i.e., < -15 mL/min/1.73 m) were associated with 61.9 % higher odds of prevalent frailty (OR = 1.619; 95 % CI: 1.353, 1.937). Compared with participants with eGFR <0.6, participants with ≥0.6 were associated with a 56.2 % lower incidence of frailty (OR = 0.438; 95 % CI: 0.304, 0.634). The magnitude of associations was not materially altered in all sensitivity analyses. eGFR was significantly associated with elevated hs-CRP, and elevated hs-CRP was significantly associated with increased risk of frailty. 5.2 % (95 % CI: 1.4 %, 13.9 %) of eGFR-associated frailty was significantly associated with elevated hs-CRP.
Negative eGFR was significantly associated with a higher risk of frailty, and the eGFR-associated frailty risk may be partially mediated by hs-CRP. Further research is needed to explore the underlying mechanisms and validate these findings in diverse populations.
本横断面研究旨在调查基于胱抑素C和肌酐的估计肾小球滤过率（eGFR）差异以及老年人衰弱风险，并探讨高敏C反应蛋白（hs-CRP）的中介作用。
使用基于胱抑素C和肌酐计算的绝对差值（eGFR）和比值（eGFR）来计算eGFR。通过范围为0至100的衰弱指数评估衰弱状态，衰弱定义为≥25。我们采用逻辑回归模型来检验不同eGFR测量值与衰弱风险之间的关联，并对社会人口学因素、生活方式和健康状况进行了调整。使用受限立方样条拟合eGFR与衰弱状态之间的非线性关联。通过中介分析探讨hs-CRP的中介作用。
我们的分析纳入了4989名参与者，中位年龄为66岁。约25%的参与者被确定为衰弱状态。在完全调整模型中，eGFR每升高15个单位，衰弱患病率的比值比（OR）降低17.0%（OR = 0.830；95%置信区间[95%CI]：0.768，0.897），eGFR每增加10%，相应的OR为0.383（95%CI：0.267，0.549）。与eGFR相似的参与者（即-15 < eGFR <15 mL/min/1.73 m²）相比，eGFR为负的组（即< -15 mL/min/1.73 m²）的衰弱患病率高61.9%（OR = 1.619；95%CI：1.353，1.937）。与eGFR <0.6的参与者相比，eGFR≥0.6的参与者衰弱发生率低56.2%（OR = 0.438；95%CI：0.304，0.634）。在所有敏感性分析中，关联强度没有实质性改变。eGFR与hs-CRP升高显著相关，hs-CRP升高与衰弱风险增加显著相关。eGFR相关的衰弱中有5.2%（95%CI：1.4%，13.9%）与hs-CRP升高显著相关。
eGFR为负与更高的衰弱风险显著相关，且eGFR相关的衰弱风险可能部分由hs-CRP介导。需要进一步研究以探索潜在机制并在不同人群中验证这些发现。
