Prevalence of CKD and comorbid illness in elderly patients in the United States: results from the Kidney Early Evaluation Program (KEEP).
Prevalence of CKD and comorbid illness in elderly patients in the United States: results from the Kidney Early Evaluation Program (KEEP).
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DOI：
10.1053/j.ajkd.2009.09.035
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发表时间：
2010-03
期刊：
影响因子：
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通讯作者：
McCullough PA
中科院分区：
文献类型：
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作者：
Stevens LA;Li S;Wang C;Huang C;Becker BN;Bomback AS;Brown WW;Burrows NR;Jurkovitz CT;McFarlane SI;Norris KC;Shlipak M;Whaley-Connell AT;Chen SC;Bakris GL;McCullough PA
患有慢性肾脏病 (CKD) 的老年患者合并症的发生率很高，包括心血管疾病及其危险因素以及 CKD 相关并发症。在年龄 ≥ 65 岁的个体中，我们试图描述根据肾脏早期评估计划 (KEEP；n = 27,017) 和国家健康和营养检查调查 (NHANES) 1999-2006 (n = 5,538) 的实验室测试结果确定的 CKD 患病率，以及根据 Medicare 5% 样本中的帐单代码确定的诊断 CKD 患病率 (n = 1,236,946)。在所有 3 个数据源中，我们还探讨了合并症和 CKD 相关并发症。 KEEP 和 NHANES 中，CKD 被确定为估计肾小球滤过率降低（<60 mL/min/1.73 m2）或白蛋白肌酐比值升高； CKD 是使用《国际疾病分类》第九版修订版、医疗保险中的临床修改代码来识别的。调查的合并症包括糖尿病、高血压、高胆固醇水平、冠状动脉疾病、充血性心力衰竭、脑血管疾病、周围血管疾病和癌症，CKD相关并发症包括贫血、低钙血症、高磷血症和甲状旁腺功能亢进。 KEEP 和 NHANES 参与者中 CKD 的患病率约为 44%，医疗保险受益人中诊断出的 CKD 患病率为 7%。在所有 3 个数据集中，年龄≥ 80 岁的参与者和患有合并症的参与者中 CKD 或诊断出的 CKD 患病率较高。对于 KEEP 和 NHANES 参与者来说，大多数合并症和 CKD 并发症的患病率随着估计肾小球滤过率的降低而增加。对于 CKD 3-5 期的参与者，KEEP 组和 NHANES 组分别有 29.2%（95% CI，27.8-30.6）和 19.9%（95% CI，17.0-23.1）患有贫血，0.7%（95% CI，0.4-0.9）和 0.6%（95% CI，0.3-1.3）患有贫血。低钙血症，5.4% (95% CI, 4.7-6.1) 和 6.4% (95% CI, 5.1-8.0) 患有高磷血症，52.0% (95% CI, 50.4-53.6) 和 30.0% (95% CI, 25.9-34.3) 患有甲状旁腺功能亢进症。 CKD 在老年人群中很常见，并且与高频率的伴随合并症和生化异常相关。由于 CKD 并不常见，因此更加重视医生教育可能是有益的。
Elderly individuals with chronic kidney disease (CKD) have high rates of comorbid conditions, including cardiovascular disease and its risk factors, and CKD-related complications. In individuals aged ≥ 65 years, we sought to describe the prevalence of CKD determined from laboratory test results in the Kidney Early Evaluation Program (KEEP; n = 27,017) and National Health and Nutrition Examination Survey (NHANES) 1999-2006 (n = 5,538) and the prevalence of diagnosed CKD determined from billing codes in the Medicare 5% sample (n = 1,236,946). In all 3 data sources, we also explored comorbid conditions and CKD-related complications. CKD was identified as decreased estimated glomerular filtration rate (<60 mL/min/1.73 m2) or increased albumin-creatinine ratio in KEEP and NHANES; CKD was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes in Medicare. Investigated comorbid conditions included diabetes, hypertension, high cholesterol level, coronary artery disease, congestive heart failure, cerebrovascular disease, peripheral vascular disease, and cancer, and CKD-related complications included anemia, hypocalcemia, hyperphosphatemia, and hyperparathyroidism. The prevalence of CKD was ~44% in both KEEP and NHANES participants, and the prevalence of diagnosed CKD was 7% in Medicare beneficiaries. In all 3 data sets, the prevalence of CKD or diagnosed CKD was higher in participants aged ≥ 80 years and those with comorbid conditions. For KEEP and NHANES participants, the prevalence of most comorbid conditions and CKD complications increased with decreasing estimated glomerular filtration rate. For participants with CKD stages 3-5, a total of 29.2% (95% CI, 27.8-30.6) in KEEP and 19.9% (95% CI, 17.0-23.1) in NHANES had anemia, 0.7% (95% CI, 0.4-0.9) and 0.6% (95% CI, 0.3-1.3) had hypocalcemia, 5.4% (95% CI, 4.7-6.1) and 6.4% (95% CI, 5.1-8.0) had hyperphosphatemia, and 52.0% (95% CI, 50.4-53.6) and 30.0% (95% CI, 25.9-34.3) had hyperparathyroidism, respectively. CKD is common in the elderly population and is associated with high frequencies of concomitant comorbid conditions and biochemical abnormalities. Because CKD is not commonly diagnosed, greater emphasis on physician education may be beneficial.