Metabolic complications in elderly adults with chronic kidney disease.
Metabolic complications in elderly adults with chronic kidney disease.
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DOI：
10.1111/j.1532-5415.2011.03818.x
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发表时间：
2012-02
影响因子：
6.3
通讯作者：
Rahman M
中科院分区：
文献类型：
--
作者：
Drawz PE;Babineau DC;Rahman M
关于老年人低肾小球滤过率（GFR）的意义存在重大争议。这项研究的目的是评估低GFR老年患者是否有贫血、高钾血症、酸中毒和高磷血症的风险。回顾性研究退伍军人事务医疗中心所有65岁以上的慢性肾病（CKD）患者，GFR在15 - 60 mL/min/1.73m2之间。贫血定义为血红蛋白<10 g/dL，高钾血症定义为钾> 5.5 mEq/L，酸中毒定义为碳酸氢盐<21 mEq/L，高磷血症定义为磷> 4.6 mg/dL。多变量逻辑回归用于评估年龄是否通过在每个模型中包括年龄和GFR之间的相互作用项来改变低GFR对代谢并发症的影响。13874名退伍军人被纳入研究。平均年龄为79岁，平均GFR为46.5; 3.1%患有贫血，2.5%患有高钾血症，2.3%患有酸中毒，4.4%患有高磷血症。在所有年龄组中，较低的GFR与代谢并发症的发生率增加相关（在多变量模型中，GFR每降低5 mL/min/1.73 m2的比值比为贫血1.21，高钾血症1.26，酸中毒1.45，高磷血症1.72）。在仅包括年龄和GFR的模型或多变量模型中，年龄与GFR之间无显著相互作用（年龄X GFR相互作用项的p值：贫血为0.66，高钾血症为0.19，酸中毒为0.54，高磷血症为0.22）。老年CKD患者存在贫血、高钾血症、酸中毒和高磷血症的风险;年龄并不能改变GFR与代谢并发症发生之间的关系。低GFR的老年患者应监测代谢并发症，无论年龄大小。
Significant controversy exists as to the meaning of a low glomerular filtration rate (GFR) in the elderly. The goal of the study was to evaluate whether elderly patients with low GFR are at risk for anemia, hyperkalemia, acidosis, and hyperphosphatemia. Retrospective study Veterans Affairs Medical Center All patients over 65 years of age with chronic kidney disease (CKD) and a GFR between 15 and 60 mL/min/1.73m2. Anemia was defined as a hemoglobin <10g/dL, hyperkalemia as a potassium >5.5mEq/L, acidosis as a bicarbonate <21mEq/L, and hyperphosphatemia as a phosphorus >4.6mg/dL. Multivariable logistic regression was used to evaluate whether age modifies the effect of low GFR on metabolic complications by including an interaction term between age and GFR in each model. 13874 veterans were included in the study. The average age was 79, the average GFR was 46.5; 3.1% had anemia, 2.5% hyperkalemia, 2.3% acidosis, and 4.4% had hyperphosphatemia. Lower GFR was associated with increased rates of metabolic complications across all age groups (odds ratio per 5mL/min/1.73m2 decrease in GFR in multivariable models was 1.21 for anemia, 1.26 for hyperkalemia, 1.45 for acidosis, and 1.72 for hyperphosphatemia). There was no significant interaction between age and GFR in models including only age and GFR or in multivariable models (p values for the age X GFR interaction term: 0.66 for anemia, 0.19 for hyperkalemia, 0.54 for acidosis, and 0.22 for hyperphosphatemia). Elderly patients with CKD are at risk for anemia, hyperkalemia, acidosis, and hyperphosphatemia; age does not modify the relationship between GFR and development of metabolic complications. Elderly patients with low GFR should be monitored for metabolic complications, regardless of age.
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影响因子：
13.6
作者：
Xue, Jay L.;Daniels, Frank;Collins, Allan J.
通讯作者：
Collins, Allan J.
影响因子：
13.6
作者：
Ishani, Areef;Xue, Jay L.;Collins, Allan J.
通讯作者：
Collins, Allan J.
影响因子：
19.6
作者：
WEIDMANN, P;DEMYTTENAEREBURSZTEIN, S;LIMA, JD
通讯作者：
LIMA, JD
影响因子：
39.2
作者：
Rule AD;Amer H;Cornell LD;Taler SJ;Cosio FG;Kremers WK;Textor SC;Stegall MD
通讯作者：
Stegall MD
影响因子：
1.4
作者：
Borzecki, AM;Wong, AT;Berlowitz, DR
通讯作者：
Berlowitz, DR