Impact of age on glomerular filtration estimates
Impact of age on glomerular filtration estimates
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DOI：
10.1093/ndt/gfn473
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发表时间：
2009-01-01
影响因子：
6.1
通讯作者：
Agharazii, Mohsen
中科院分区：
文献类型：
--
作者：
Douville, Pierre;Martel, Ariane R.;Agharazii, Mohsen
背景成人肾小球滤过率随年龄增长而逐渐降低。预测方程应该有适当的建模，以充分考虑正常衰老。对773例18 ~ 90岁的门诊患者进行了校正的24小时肌酐清除率（CCL）测定。采用多元线性回归分析年龄对肾小球滤过率的影响。与简化的MDRD和马约方程进行了比较。在第二组7551例血清肌酐正常的患者中检验推导方程的影响。虽然所有方程都显示随着年龄的增长功能下降，但我们的研究结果表明，GFR在30岁后逐渐下降，并在60岁后继续稳步下降。这导致多元回归分析中的凸曲线，其最好由包括二次项（年龄（2））的方程拟合。相比之下，MDRD方程在成年早期产生更快的下降，60岁后曲线更平坦，而马约方程产生更线性的影响。MDRD结果在正常范围内低于马约方程估计值。这些方程应用于7551例18 ~ 102岁正常门诊患者的独立队列研究，得出GFR随年龄变化的不同曲线。在估计GFR的公式中纳入年龄的二次项，可以更好地模拟与衰老相关的肾功能自然下降。此外，随着GFR在30岁以后稳步下降，所有年龄的GFR正常值的单一截止值导致年轻人诊断不足和老年人诊断过度。指南应考虑正常人群中观察到的肾功能随年龄的降低，以最佳评估eGFR。
Background. Glomerular filtration decreases progressively with age in adults. Predictive equation should have proper modelling to adequately account for normal senescence.Methods. Corrected 24-h creatinine clearances (CCLs) were measured in a cohort of 773 outpatients from 18 to 90 years old. Multiple linear regression was used to model the effect of age on glomerular filtration. Comparisons were made with the simplified MDRD and the MAYO equations. Impact of the derived equation was tested in a second cohort of 7551 patients with normal serum creatinine.Results. While all equations show declining function with age, our results suggest that the GFR reduction is progressive after the age of 30 and continue to decline steadily after the age of 60. This leads to a convex curve in the multiple regression analysis that is best fitted by an equation including the quadratic term (age(2)). In contrast, the MDRD equation produces a faster decrease in early adulthood and a flatter curve after the age of 60 while the MAYO equation produces a more linear effect. MDRD results in the normal range are lower than those estimated by the MAYO equation. These equations, as applied on an independent cohort of 7551 normal outpatients from 18 to 102 years, produce different profile of evolution of GFR with age.Conclusions. Inclusion of a quadratic term for age in the formula estimating GFR results in better modelling of the natural decline of renal function associated with ageing. Furthermore, as GFR steadily declines after the age of 30, a single cut-off value of GFR normality for all ages leads to underdiagnosis of young adults and over diagnosis of elderly individuals. Guidelines should take into account the observed reduction of kidney function with age in normal population for optimal evaluation of eGFR.