老年患者慢性肾脏病诊断率的调查研究

Survey on diagnostic rate of chronic kidney disease in elderly patients

目的回顾性研究老年住院患者慢性肾脏病(CKD)的诊断情况,探讨引起老年CKD诊断率差异的因素。方法以1 042例具有3个月以上完整病历资料的内科老年住院患者为研究对象,并以病历首页资料齐全的4 984例内科老年住院患者的首页内科诊断目录进行对比分析。采集尿常规、尿白蛋白、尿肌酐、血肌酐、尿素氮、肾脏B超检查结果,用CKD-EPI公式估算肾小球滤过率(eGFR)。结果 1肾病科医师依据2012年KDIGO-CKD诊断标准进行诊断,CKD诊断率为33.49%;内科医师以"慢性肾小球肾炎、肾小管间质疾病、继发性肾脏疾病、慢性肾功能不全"作为CKD诊断依据,CKD诊断率为10.67%,差异有显著统计学意义(P<0.01);218.33%的老年住院患者被漏诊,CKD G2期和G3a期患者是被漏诊的主要人群;3随年龄增加,CKD诊断率增加,差异有显著统计学意义(P<0.01)。结论医师认知不同、加上肾功能随增龄的变化,是老年患者CKD诊断率差异的主要因素。提高医师对老年CKD的认知,能及时、准确诊断老年CKD。

Objective To study the diagnostic status and to explore the factors causing different diagnostic rate of chronic kidney disease（ CKD） in elderly patients. Methods The clinical data of 1 042 elderly inpatients with complete records for 3 months were retrospectively reviewed and analyzed. As controls,the diagnostic data of 4 984 elderly patients were recorded and studied. Urine routine examination,urinary albumin,urine creatinine,serum creatinine,urea nitrogen,and renal ultrasound were examined and collected. Glomerular filtration rate（ GFR）was calculated by CKD-EPI formula. Results 1The diagnostic rate of CKD in elderly patients was 33. 49% by kidney specialists,and it was higher than that by physicians（ 10. 67%）（ P〈 0. 01）. 2Chronic kidney disease in 18. 33% of total 1 042 elderly inpatients might be missed due to lack of awareness of physicians,and it was mainly in the stages G2 and G3 of CKD. 3The diagnostic rate of CKD was increased with the increase of age（ P 〈 0. 01）. Conclusion The awareness of various physicians and special change of renal function with age in old persons may be main factors leading to different diagnostic rate of CKD. It is important to raise the awareness of physicians,in order to accurately diagnose CKD in elderly patients on time.