住院患者慢性肾脏病患病情况的调查

Prevalence of chronic kidney disease in Chinese hospitalized adult patients:investigation of 13 383 cases

目的我国有关慢性肾脏病(CKD)流行情况的大样本临床调查资料报道较少,本研究拟在调查三级甲等医院住院患者 CKD 的患病情况。方法回顾性分析了2004年9月到2005年8月在南京市中大医院(三级甲等)住院的所有成人患者(≥18岁)的病历资料,共16 946份病历,剔除未检查肾功能的病历和同一患者重复住院的病历,最终有效入选病历为13 383份,男性6215例,女性7168例,观察患者的性别、年龄、高血压和糖尿病史、吸烟史、血压、肾功能、尿酸、白蛋白、血红蛋白、红细胞压积、血脂、尿蛋白等多项指标,参照 NKF-K/DOQI 指南的标准来定义 CKD,以简化的 MDRD公式求 eGFR。结果本研究中 CKD 患病率14.82%,其中 CKD1-5期患者所占比例分别为3.33%、2.49%、7.07%、1.08%和0.86%。大于65岁的老年患者占 CKD 的53.07%,其 CKD 患病率高于中青年患者(P<0.001)。9.01%的患者 eGFR 低于60 ml·min^(-1)·(1.73 m^2)^(-1),老年患者 eGFR 降低比例高于中青年患者(P<0.001)。尿蛋白阳性率8.87%,老年患者阳性率高于中青年患者(P<0.001)。高血压、糖尿病和原发性肾小球疾病是导致 CKD 的主要病因,分别占29.49%、11.64%、4.39%。有39.06%的 CKD 患者在住院期间未能做出 CKD 诊断,且都为 CKD1-3期患者。Logistic 回归提示高血压、糖尿病、年龄增长是 CKD 的重要危险因素。结论 CKD 是住院成人患者常见的一种慢性疾病,老年人是高危人群,高血压、糖尿病是最主要的病因,积极应用 K/DOQI 指南标准及时做出CKD 诊断,对早期预防和积极干预 CKD,降低终末期肾脏疾病的发生具有重要意义。

Objective To retrospectively investigate the prevalence and distribution of chronic kidney disease （CKD） in hospitalized Chinese adult patients. Methods The medical histories of 13383 adult patients hospitalized in Zhongda Hospital from September 2004 to August 2005, 6215 males and 7168 female, aged （51 ＋ 19 ） （18 - 103 ）, were reviewed. The blood pressure, serum creatinine, proteinuria were investigated. CKD was defined and classified according to the NKF/DOQI guideline. Glomerular filtration rate （GFR） was estimated by using the simplified modification of diet in renal disease study （MDRD） equation, eGFR = 186.3 × serum creatinine^-1.154 ×age^-0.203 ×（0. 742 for women） ml ·min^-1· （ 1.7 3 m^2 ）^ -1. Results The prevalence rate of CKD was 14.82% in this group, and the prevalence rates of CKD of stage 1 to 5 were 3.33%, 2.49%, 7.07%, 1.08%, and 0.86% respectively. 53.07% of the CKD patients were elderly patients （age 〉 65 ） with a CKD prevalence rate of 29.47%, significantly higher than that of the middle-aged and young patients （9.49%, P 〈 0.01 ）. The eGFR levels of 9.01% of the hospitalized patients were below 60 ml ·min^-1·（ 1.73 m^2 ） ^-1. The prevalence rate of proteinuria was 8. 87%. 39. 06% of the patients at stages 1 - 3 failed to be diagnosed as with CKD during their hospitalization. The most common causes of CKD were hypertension （29.49%）, diabetes （11.64% ）, and primary glomerulonephritis （4.39%）. Hypertension, diabetes and being elderly were main risk factors for CKD. Conclusion CKD is a very common disease among the hospitalized patients in China. With the increasing number of aging populations, elderly people will be the highest risk group for CKD. More strategies have to be made for its early detection and prevention.