Mortality risk stratification in chronic kidney disease: One size for all ages?
Mortality risk stratification in chronic kidney disease: One size for all ages?
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DOI：
10.1681/asn.2005090986
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发表时间：
2006-03-01
影响因子：
13.6
通讯作者：
Walter, Louise C.
中科院分区：
文献类型：
--
作者：
O'Hare, Ann M.;Bertenthal, Daniel;Walter, Louise C.
目前的国家肾脏基金会肾脏病结局质量倡议慢性肾脏病（CKD）分期标准适用于所有年龄组。然而，目前尚不清楚不同水平的估计GFR（eGFR）是否在老年和年轻患者中具有相同的预后意义。研究队列由退伍军人事务部（VA）的患者组成，年龄在18至100岁之间，在2001年10月1日至2002年9月30日期间至少有一次门诊血清肌酐测量（n = 2583，911）。排除ESRD患者。使用肾脏疾病饮食改良公式，使用研究期间每例患者的首次门诊肌酐测量值估计GFR。按年龄组测量eGFR与生存率的相关性。20%的队列患者eGFR < 60 ml/min/1.73 m2，范围从18- 44岁的3%到85- 100岁的49%。在eGFR < 60 ml/min/1.73 m2的队列患者中，有52%（n = 266，421）的eGFR“非常”中度降低至50 - 59 ml/min/1.73 m2范围。eGFR与死亡率的相关性在老年组比在年轻组弱：在所有年龄组中，eGFR的严重降低与死亡风险增加相关，而eGFR的“非常”中度降低（50 - 59 ml/min/1.73 m2）仅与65岁以下患者的校正死亡风险增加相关。eGFR与死亡率的相关性也存在于女性和黑人患者中。在临床环境中，老年患者的死亡风险分层不应基于与年轻年龄组相同的eGFR临界点，并且将受益于30- 59-ml/min/1.73 In 2 eGFR组的更精细分类。
Current National Kidney Foundation Kidney Disease Outcomes Quality Initiative staging criteria for chronic kidney disease (CKD) are intended to apply to all age groups. However, it is unclear whether different levels of estimated GFR (eGFR) have the same prognostic significance in older and younger patients. The study cohort was composed of Department of Veterans Affairs (VA) patients who were aged 18 to 100 yr and had at least one outpatient serum creatinine measurement between October 1, 2001, and September 30, 2002 (n = 2583,911). Patients with ESRD were excluded. GFR was estimated using the Modification of Diet in Renal Disease equation using each patient's first outpatient creatinine measurement during the study period. The association of eGFR with survival was measured by age group. Twenty percent of cohort patients had an eGFR < 60 ml/min per 1.73 m(2), ranging from 3% among 18- to 44-yr-olds to as high as 49% among 85- to 100-yr-olds. Fifty-two percent (n = 266,421) of cohort patients with an eGFR < 60 ml/min per 1.73 m(2) had "very" moderate reductions in eGFR into the 50 to 59-ml/min per 1.73 m(2) range. The association of eGFR with mortality was weaker in the elderly than in younger age groups: Whereas severe reductions in eGFR were associated with an increased risk for death in all age groups, "very" moderate reductions in eGFR (50 to 59 ml/min per 1.73 m(2)) were associated with an increased adjusted risk for death only among patients who were younger than 65 yr. Age-related attenuation of the association of eGFR with mortality was also present among women and black patients. In the clinical setting, mortality risk stratification in elderly patients should not be based on the same eGFR cut points as for younger age groups and would benefit from finer categorization of the 30- to 59-ml/min per 1.73 In 2 eGFR group.