老年慢性肾病不同分期患者躯体功能及合并疾病的比较

A comparative study of physical function and comorbidity burden of elderly patients with chronic kidney disease at different stages

目的对老年慢性肾病(chronic kidney disease,CKD)患者躯体功能及合并疾病进行评估,比较不同分期患者躯体功能及合并疾病的差异。方法研究对象为2016年1月1日-2017年12月31日在本院老年肾病科住院的CKD患者,根据肾小球滤过率(estimate glomerular filtration rate,eGFR)将患者分为3a期、3b期、4期、5期,采用巴氏指数(Barthel index)和改良老年疾病累计评分表(modified cumulative illness rating scale-geriatric,MCIRS-G)分别评估患者躯体功能和合并疾病情况,比较不同分期患者的躯体功能及合并疾病的差异并进行相关性分析。结果本研究共纳入84例老年男性CKD患者,平均年龄(85.12±8.99)岁。老年CKD患者4期的躯体功能(Barthel Index)较3a期和5期差(55.00±28.72 vs 77.50±23.66和78.00±22.01,P均<0.05),4期的血清白蛋白水平低于3a期和5期[(35.45±4.50) g/L vs (39.18±2.76) g/L和(39.32±3.04) g/L,P <0.05],3a期疾病累计评分(MCIRS-G)低于4期(26.25±3.17 vs 28.82±1.94,P <0.05),其中糖尿病的发病率随疾病分期进展逐渐升高(P <0.05)。相关性分析中,疾病累计评分与巴氏指数呈负相关(r=-0.636,P <0.05),血清白蛋白水平与巴氏指数呈正相关(r=0.400,P <0.05)。结论在高龄老年CKD患者中,CKD分期与患者躯体功能及合并疾病相关。CKD 4期是躯体功能下降及合并严重疾病的高风险时期。

Objective To assess the physical function and comorbidity burden of elderly patients with chronic kidney disease（CKD） and compare the difference between each stage. Methods The participants were military elderly patients with CKD hospitalized in the department of geriatric nephrology of our hospital from January 1, 2016 to December 31, 2017. Based on the estimate glomerular filtration rate（eGFR）, they were divided into stage 3a, 3b, 4, and 5 groups. The Barthel index and modified cumulative illness rating scale-geriatric（MCIRS-G） were used to evaluate the patients＇ physical function and the comorbidity burden in order to compare the difference of each stage and analyze the correlation of different characteristics. Results A total of 84 male elderly patients with CKD were recruited in the study, with mean age of（85.12±8.99） years. The physical function of patients in stage 4 was worse than that of stage 3a and 5（55.00±28.72 vs77.50±23.66 and 78.00±22.01, P〈0.05 respectively）. The albumin of patients in stage 4 was lower than that of stage 3a and stage 5 [（35.45±4.50） g/L vs（39.18±2.76） g/L and（39.32±3.04） g/L, P〈0.05 respectively]. The MCIRS-G score of stage 3a was lower than that of stage 4（26.25±3.17 vs 28.82±1.94, P〈0.05）. The incidence of diabetes increased with the progression of CKD（P〈0.05）. In the correlation analysis, the score of MCIRS-G had negative correlation with the score of Barthel Index（r =-0.636, P〈0.05）, while albumin had positive correlation with the score of Barthel Index（r =0.400,P〈0.05）. Conclusion For elderly population, CKD is associated with physical function decline and comorbidity burden. The stage 4 is the high risky period of physical function decline and being stricken with comorbidity burden.