Increased risk of mortality in the elderly population with late-stage chronic kidney disease: a cohort study in Taiwan
Increased risk of mortality in the elderly population with late-stage chronic kidney disease: a cohort study in Taiwan
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DOI：
10.1093/ndt/gfn222
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发表时间：
2008-10-01
影响因子：
6.1
通讯作者：
Mau, Lih-Wen
中科院分区：
文献类型：
--
作者：
Hwang, Shang-Jyh;Lin, Ming-Yen;Mau, Lih-Wen
背景台湾是世界上终末期肾病（ESRD）发病率最高和患病率第二高的地区，尤其是在老年人群中。然而，从慢性肾病（CKD）到死亡或ESRD的转变仍不清楚。本研究旨在通过确定CKD人群来研究晚期CKD对全因和病因特异性死亡率的影响。这是一项观察性队列研究（n = 35 529），平均年龄75.7岁（SD = 5.3），参与者在老年人健康检查计划（EHEP）在高雄市，台湾，2002年至2004年。肾小球滤过率（eGFR）采用简化的肾脏疾病饮食方程计算。通过考克斯回归分析评估与晚期CKD相关的死亡率的比例风险比（HR）。CKD 3-5期的粗患病率为39.4%; 1840名参与者（5.18%）在2年随访期内死亡，总体死亡率为20.3/1000人年，参考组为16.4/1000人年。在eGFR降低的组中，发现全因和原因特异性死亡率的HR较高。与参照组（eGFR > 60 mL/min/1.73 m2）相比，eGFR 30-44、15-29和< 15 mL/min/ 1.73 m2组的全因死亡率校正HR分别为1.5、2.1和2.6（P < 0.001）。心血管或肾脏疾病死亡率高的HR也与eGFR降低显著相关（P <0. 05）。晚期慢性肾脏病是台湾老年人死亡的重要危险因素，尤其是心血管和肾脏疾病。鉴于研究区域中晚期CKD的患病率较高，CKD患者死亡率相对较低，这可能反映了对早期CKD患者肾功能的低估，或部分解释了高ESRD人群。
Background. Taiwan has the world's highest incidence and second highest prevalence of end-stage renal disease (ESRD), particularly in older age groups. However, the transition from chronic kidney disease (CKD) to death or ESRD remains unclear. This study aimed to investigate the impact of late-stage CKD on all-cause and cause-specific mortality by identifying the CKD population.Methods. This was an observational cohort study (n = 35 529), mean age 75.7 years (SD = 5.3), of participants in the Elderly Health Examination Program (EHEP) in Kaohsiung City, Taiwan, between 2002 and 2004. Estimated glomerular filtration rate (eGFR) was calculated by the simplified modified diet in renal disease equation. Proportional hazard ratios (HR) of mortality associated with late-stage CKD were assessed by Cox regression.Results. The crude prevalence rate of CKD stages 3-5 was 39.4%; 1840 participants (5.18%) died within 2-year follow-up, a mortality rate of 20.3 per 1000 person-years overall and 16.4 per 1000 person-years in the reference group. Higher HR for all-cause and cause-specific mortality were found in the groups with decreased eGFR. Compared with the reference group (eGFR > 60 mL/min/1.73 m(2)), adjusted HR for all-cause mortality were 1.5, 2.1 and 2.6 for groups with eGFR 30-44, 15-29 and < 15 mL/min/ 1.73 m(2), respectively (P < 0.001). Higher HR of mortality due to cardiovascular or renal diseases were also significantly associated with decreased eGFR (P < 0.05).Conclusion. Late-stage CKD is a significant risk factor for mortality, especially due to cardiovascular and renal diseases, in elderly Taiwanese. Given the higher prevalence rate of late-stage CKD in the study area, CKD patient mortality was relatively lower, which might reflect underestimation of renal function for patients at early stages of CKD, or partly explain the high ESRD population.