3～4期慢性肾脏病老年患者病情进展的影响因素分析

Factors analysis of disease progression in elderly patients with chronic kidney disease stages 3～4

目的探讨3~4期慢性肾脏病(CKD)老年患者病情进展的影响因素。方法选取2007年1月至2014年9月期间规律随访超过1年的105例老年CKD 3~4期患者为研究对象,基线肾小球滤过率估计值(eGFR)为(37.4±9.0)ml·min^(-1)·1.73 m^(-2),76例患者处于G3期,29例患者处于G4期;根据其随访过程中的eGFR变化分为恶化组25例和非恶化组80例。比较G3期和G4期以及恶化组和非恶化组的基线资料和随访结果,采用多因素Logistic回归探讨患者发生肾功能恶化的影响因素。结果 G4期患者的eGFR、血红蛋白(Hb)、血碳酸氢根水平低于G3期患者,尿蛋白分级、尿蛋白及磷(P)浓度高于G3期患者(P<0.05)。恶化组基线eGFR、基线Hb、基线血碳酸氢根、随访Hb、随访血碳酸氢根、服用肾素-血管紧张素-醛固酮系统拮抗剂(RASI)的患者比率明显低于未恶化组,基线尿蛋白分级、基线尿蛋白、基线血P浓度、基线收缩压(SBP)、随访SBP、随访血P浓度明显高于未恶化组(P<0.05)。多因素Logistic回归结果表明基线eGFR分为G4期、随访过程中的收缩压(SBP)>140 mm Hg是患者发生肾功能恶化的独立危险因素(P<0.05)。结论随访过程中的SBP>140 mm Hg能显著增加老年CKD 3~4期患者发生肾功能恶化,建议以140 mm Hg作为SBP的治疗靶目标值,重视血压的个体化管理。

Objective To explore the effect of blood pressure on disease progression in elderly patients with chronic kidney disease（ CKD） stages 3 - 4. Methods 105 elderly patients with baseline CKD stages 3 - 4 and more than one year follow- up in our renal medicine from January 2007 to September 2014 were enrolled in the study. The baseline eGFR of total patients was（ 37. 4 ± 9. 0） ml·min^- 1·1. 73 m^- 2.76 cases were classified as stage G3,29 cases as stage G4 respectively. According to baseline eGFR,they were divided into deterioration group（ 25 cases） and no deterioration group（ 80 cases）. Baseline data and follow- up result were compared between two groups. Multivariate logistic regression analysis was performed to investigate the related factors of deterioration of renal function. Results The levels of eGFR,hemoglobin（ Hb）,blood bicarbonate were significantly lower in patients with G4 than those in G3,Urine protein,urinary protein and phosphorus（ P） concentration were significantly higher in patients with G4 than those in G3（ P〈0. 05）. In the worsening group,Baseline eGFR,baseline Hb,baseline blood bicarbonate,follow- up Hb,follow- up blood bicarbonate,rate of patients taking renin- angiotensin- aldosterone system antagonist（ RASI） were significantly lower than those of the non- worsening group（ P〈0. 05）. Baseline urinary protein,baseline proteinuria,baseline blood P concentration,baseline SBP,follow- up SBP,follow- up blood P concentration were significantly higher than those of the non-worsening group（ P〈0. 05）. Result of multivariate logistic regression analysis showed that stage G4 according to baseline eGFR and systolic blood pressure（ SBP） during follow- up 140 mm Hg were independent risk factors of deterioration of renal function（ P〈0. 05）. Conclusion SBP 140 mm Hg during follow- up could significantly increase the risk of deterioration of renal function in elderly patients with baseline CKD stages 3 -4,so we suggested 140 mm Hg as treatment target of SBP and pay great attention to the individualized management of blood pressure.