Estimated GFR and Mortality in Older Men: Are All eGFR Formulae Equal.
Estimated GFR and Mortality in Older Men: Are All eGFR Formulae Equal.
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DOI：
10.1159/000445757
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发表时间：
2016
影响因子：
4.2
通讯作者：
Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study
中科院分区：
文献类型：
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作者：
Canales MT;Blackwell T;Ishani A;Taylor BC;Hart A;Barrett-Connor E;Lewis C;Beyth RJ;Stone K;Ensrud KE;Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study
最近，第一个专门为社区居住的老年人开发的eGFR公式BIS2被报道。然而，迄今为止，还没有研究将BIS2在预测老年人死亡方面的表现与临床和研究中使用的公式进行比较。我们前瞻性随访了2,994名社区居住男性（年龄76.4±5.6岁），他们参加了mrs睡眠研究。我们使用BIS2、CKD-EPIcr、cysc、ckd - epicc和CKD-EPIcr方程计算血清肌酐和胱抑素- c的基线eGFR。分析包括cox -比例风险回归和净重分类改善（NRI）对全因死亡和心血管死亡的结果。随访时间7.3±1.9年。到BIS2时，与CKD-EPIcr（23%和6%）、ckd - epicc（36%和13%）和CKD-EPIcr，cysc（28%和8%）相比，分别有42%和11%的患者eGFR <60和<45。多因素调整后，与eGFR≥75相比，BIS2 eGFR <45与2倍高的全因死亡率相关（HR 2.1, 95% CI 1.5-2.8）。CKD-EPIcr的结果相似，cysc <45 （HR 2.1, 95% CI 1.6-2.7）和ckd - epicc <45 (HR 2.1, 95% CI 1.7-2.7), CKD-EPIcr <45的结果较弱（HR 1.5, 95% CI 1.2-2.0）。在NRI分析中，与CKD-EPIcr、cysc相比，BIS2和CKD-EPIcr方程更容易在死亡率方面对参与者进行错误分类。我们在心血管死亡中发现了类似的结果。在该老年男性队列中，BIS2并不优于ckd - epr，并且ckd - epr在预测死亡方面不如基于胱抑素c的CKD-EPI方程。因此，基于胱抑素c的CKD-EPI方程是预测社区居住老年男性死亡的首选公式。
Recently, the first eGFR formula specifically developed for community-dwelling older adults, the BIS2, was reported. To date, however, no study has examined the performance of the BIS2 to predict death in older adults as compared to equations used clinically and in research. We prospectively followed 2,994 community-dwelling men (age 76.4 ±5.6 years) enrolled in the MrOS Sleep Study. We calculated baseline eGFR from serum creatinine and cystatin-C using the BIS2, CKD-EPIcr,cysc, CKD-EPIcysc and CKD-EPIcr equations. Analyses included Cox-proportional hazards regression and net-reclassification improvement (NRI) for the outcomes of all-cause and cardiovascular death. Follow-up time was 7.3 ±1.9 years. By BIS2, 42% and 11% had eGFR <60 and <45, respectively, compared to CKD-EPIcr (23% and 6%), CKD-EPIcysc (36% and 13%) and CKD-EPIcr,cysc (28% and 8%). BIS2 eGFR <45 was associated with 2-fold higher rate of all-cause mortality when compared to eGFR ≥75 after multivariate adjustment (HR 2.1, 95% CI 1.5–2.8). Results were similar for CKD-EPIcr,cysc <45 (HR 2.1, 95% CI 1.6–2.7) and CKD-EPIcysc <45 (HR 2.1, 95% CI 1.7–2.7) and weaker for CKD-EPIcr <45 (HR 1.5, 95% CI 1.2–2.0). In NRI analyses, when compared to CKD-EPIcr,cysc, both BIS2 and CKD-EPIcr equations more often misclassified participants with respect to mortality. We found similar results for cardiovascular death. The BIS2 did not outperform and the CKD-EPIcr was inferior to the cystatin c-based CKD-EPI equations to predict death in this cohort of older men. Thus, the cystatin C-based CKD-EPI equations are the formulae of choice to predict death in community-dwelling older men.