Prevalence and Severity of Chronic Kidney Disease and Anemia in the Nursing Home Population
Prevalence and Severity of Chronic Kidney Disease and Anemia in the Nursing Home Population
复制标题
DOI：
10.1016/j.jamda.2009.07.003
复制
发表时间：
2010-01-01
影响因子：
7.6
通讯作者：
Ouslander, Joseph G.
中科院分区：
文献类型：
--
作者：
McClellan, William M.;Resnick, Barbara;Ouslander, Joseph G.
目的：慢性肾脏病（CKD）是一种新出现的健康问题，可能对患有许多其他慢性疾病的老年人（如养老院（NH）居民）的管理具有重要意义。本研究的目的是描述慢性肾脏病的患病率和相关的合并症在一个代表性样本的NH residents.Design：横断面描述性研究作为一个组成部分的一个前瞻性观察性研究慢性肾脏病和贫血在NH population.Setting：82个地理代表性的NH在美国。Participants：Participants是794 NH residents who had complete baseline data collected. Measures：获得知情同意的居民接受了记录审查，重点是确定一组预定义的共病状况、临床评估以及血液和尿液采集。CKD分期基于使用MDRD方程估计的GFR（eGFR）：无CKD（eGFR > 60 mL/min/1.73 m（2））、3a期（4/5 -59）、3b期（30-44）和4/5期（< 30）。结果：筛查的1626名居民中，获得了847名居民的同意; 32人不符合资格，21人退出研究;共有794名居民获得了完整的数据。约50%的居民存在CKD;在这些CKD居民中，47.6%为3a期，39.27%为3b期，13.2%为4/5期。50%的人患有贫血，贫血在CKD患者中更常见。人群中合并症的平均数量为5.3（SD 2.2）;合并多种疾病（尤其是心血管疾病）的患者比例随着CKD分期的增加而增加。在那些没有慢性肾脏病，57%有5个或更多的合并症相比，87%的4/5期CKD.Conclusions：在这个有代表性的样本794美国NH居民，50%的慢性肾脏病的临床证据。CKD患者，特别是那些晚期患者，更有可能患有心血管合并症和贫血。这些疾病在住院人群中的同时发生可能对该患者人群的临床管理具有重要意义，特别是因为它涉及进一步肾脏并发症的可能性。（《美国医学博士杂志》，2010年; 11：33-41）
Objectives: Chronic kidney disease (CKD) is an emerging health concern and may have important implications for the management of older people with many other chronic conditions, such as the nursing home (NH) resident population. This study was designed to describe the prevalence of CKD and associated comorbidities in a representative sample of NH residents.Design: Cross-sectional descriptive study as a component of a prospective observational study of CKD and anemia in the NH population.Setting: Eighty-two geographically representative NHs in the United States.Participants: Participants were 794 NH residents who had complete baseline data collected.Measurements: Residents for whom consent was obtained underwent a record review focused on identifying a predefined set of comorbid conditions, clinical assessment, and blood and urine collections. Stage of CKD was based on estimated GFR (eGFR) using the MDRD equation: no CKD (eGFR > 60 mL/min/1.73 m(2)), Stage 3a (45-59), Stage 3b (30-44), and Stage 4/5 (< 30).Results: Consent was obtained from 847 of 1626 residents screened; 32 were ineligible and 21 dropped out of the study; complete data were available for 794 residents. CKD was present in approximately 50% of residents; of these residents with CKD, 47.6% were stage 3a, 39.27% stage 3b, and 13.2% stage 4/5. Fifty percent of the population had anemia, and anemia was more common in those with CKD. The average number of comorbid conditions in the population was 5.3 (SD 2.2); the proportion of patients with multiple comorbid conditions, especially cardiovascular conditions, increased with increasing stage of CKD. Among those without CKD, 57% had 5 or more comorbidities in comparison to 87% of those with stage 4/5 CKD.Conclusions: In this representative sample of 794 US NH residents, 50% had clinical evidence of CKD. Patients with CKD, particularly those at later stages, were more likely to have cardiovascular comorbidities and anemia. The co-occurrence of these conditions in institutionalized populations may have important implications for the clinical management of this patient population, particularly as it relates to the potential for further renal complications. (J Am Med Dir Assoc 2010; 11: 33-41)