Distribution of survival times in a real-world cohort of older adults with chronic kidney disease: the median may not be the message.
Distribution of survival times in a real-world cohort of older adults with chronic kidney disease: the median may not be the message.
复制标题
现实世界中患有慢性肾病的老年人群的生存时间分布：中位数可能不是信息。
DOI：
10.1111/jgs.13425
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发表时间：
2015
影响因子：
6.3
通讯作者：
O'Hare,AnnM
中科院分区：
文献类型：
--
作者：
Bowling,CBarrett;Batten,Adam;O'Hare,AnnM
方法我们的分析队列包括357,632名退伍军人，年龄在70岁及以上，2001财政年度在退伍军人事务部（VA）医疗保健系统中至少有一次门诊血清肌酐测量，未接受长期透析，未接受肾移植，且至少有一次尿蛋白测试。我们使用慢性肾脏疾病流行病学协作方程来估计GFR。根据当前指南中推荐的分类系统，根据eGFR和蛋白尿水平对患者进行分类，但我们使用eGFR切割点75 ml/min/1.73 m2来定义eGFR最高的分层，因为小于1%(n= 126)≥85岁的队列成员的eGFR≥89 ml/min/1.73 m2。1 CKD定义为eGFR< 60 ml/min/1.7 m2或≥1+蛋白尿。我们分别计算了CKD患者和非CKD患者的年龄分层中位生存期和四分位数范围（25 - 75百分位数）。此外，我们计算了按年龄组、eGFR类别和蛋白尿水平分层的中位生存率。生命状态一直持续到2013年7月23日。结果当按年龄组、eGFR和蛋白尿水平分层时，不同疾病风险层的生存时间在年龄组内和年龄组间都有很大差异（表）。例如，在75 - 79岁的患者中，eGFR最低、蛋白尿最高的患者中位生存时间为3.4年，而eGFR≥75 ml/min/1.73 m2、蛋白尿阴性的患者中位生存时间为8.3年。在各个年龄组中，中位生存期从最低eGFR水平和最高蛋白尿水平的85岁及以上患者的低至1.9年，到最高eGFR水平和最低蛋白尿水平的70-74岁患者的高至11.0年。总体而言，CKD患者的中位生存期比其他队列成员更有限（6.5年对9.1年）。
MethodsOur analytic cohort consisted of 357,632 Veterans aged 70 years and older with at least one outpatient serum creatinine measure within the Department of Veterans Affairs (VA) healthcare system in Fiscal Year 2001, who were not receiving long-term dialysis, had not received a kidney transplant, and who had at least one urine protein dipstick measurement. 7 We used the Chronic Kidney Disease Epidemiology Collaboration equation to estimate GFR. Patients were classified by eGFR and proteinuria levels based on the classification system recommended in current guidelines with the exception that we used an eGFR cut point of 75 ml/min/1.73 m 2 to define the highest eGFR strata because less than 1%(n= 126) of cohort members≥ 85 years had an eGFR≥ 89 ml/min/1.73 m 2. 1 CKD was defined as an eGFR< 60 ml/min/1.7 m 2 or≥ 1+ proteinuria. We calculated age-stratified median survival and interquartile range (25th–75th percentiles) separately for those with and without CKD. Additionally we calculated median survival stratified by age group, eGFR category and level of proteinuria. Vital status was current through July 23, 2013.ResultsWhen stratified by age group, level of eGFR and proteinuria, there were large differences in survival time across disease-based risk strata both within and across age groups (Table). For example, among those 75–79 years old, median survival time ranged from 3.4 years among those with the lowest levels of eGFR and highest levels of proteinuria to 8.3 years among those with an eGFR≥ 75 ml/min/1.73 m 2 and negative to trace proteinuria. Across age groups, median survival ranged from a low of 1.9 years for those aged 85 years or older with the lowest levels of eGFR and highest levels of proteinuria to a high of 11.0 years for those aged 70–74 years with the highest levels of eGFR and lowest levels of proteinuria. Overall, median survival was more limited for those with CKD than for other cohort members (6.5 vs. 9.1 years).