老年男性慢性肾脏病患者衰弱的影响因素

Related factors of frailty in the elderly male patients with chronic kidney disease

目的探讨老年男性慢性肾脏病(CKD)患者衰弱的影响因素,以期为老年人衰弱的临床干预提供依据。方法纳入2018年10月1日至2019年1月30日在解放军总医院就诊的年龄≥65岁的105例男性非透析CKD患者。收集患者一般资料及相关实验室指标,采用Fried衰弱诊断标准评估患者的衰弱情况。根据评分标准将CKD患者分为无衰弱组(37例),衰弱早期组(37例)和衰弱组(31例)。多因素logistic回归分析估算肾小球滤过率(eGFR)与衰弱的相关性。结果105例患者年龄74(68,77)岁,衰弱早期及衰弱的发生率分别为35.2%(37/105)和29.5%(31/105)。多因素logistic回归分析结果显示,衰弱与年龄呈正相关(OR=1.14,95%CI:1.08~1.20,P<0.001),与体质指数(OR=0.87,95%CI:0.79~0.95,P=0.001)和eGFR(OR=0.98,95%CI:0.96~0.99,P=0.003)呈负相关。调整年龄、体质指数、血红蛋白、血尿酸、低密度脂蛋白胆固醇、脑利钠肽前体等因素后,eGFR<45 ml·min^-1·(1.73 m^2)^-1和45~59 ml·min^-1·(1.73 m^2)^-1的老年男性CKD患者与eGFR≥60 ml·min^-1·(1.73 m^2)^-1的患者相比,衰弱的发生率分别增加了1.02倍(OR=2.02,95%CI:1.06~3.87)和0.84倍(OR=1.84,95%CI:1.05~3.22)。结论老年男性CKD患者衰弱的发生受年龄、体质指数及肾功能等多种因素影响,且衰弱的发生率随着肾功能的下降而增加。

Objective To investigate the characteristics of frailty in the elderly male patients with chronic kidney disease(CKD)and the effects of renal function on the incidence of frailty.Methods A total of 105 non-dialysis CKD patients aged≥65 years who were admitted to the Chinese PLA General Hospital between October 1,2018 and January 30,2019 were included in this study.Their clinical data and laboratory indicators were collected.Frailty was defined according to Fried frailty criteria.According to the frailty scores,the participants were categorized as non-frail(n=37),intermediately frail(n=37)and frail(n=31).The association of frailty and the level of estimated glomerular filtration rate(eGFR)in the patients was analyzed using the model of multivariate Logistic regression.Results Among the 105 patients,the mean age was 74(68,77)years old.The incidence of frail and intermediate frail was 35.2%(37/105)and 29.5%(31/105),respectively.Multivariate logistic analysis showed statistically significant associations of frailty with age(OR=1.14,95%CI:1.08-1.20,P<0.001),body mass index(OR=0.87,95%CI:0.79-0.95,P=0.001)and the level of eGFR(OR=0.98,95%CI:0.96-0.99,P=0.003)in those patients.The incidence of frail in patients with eGFR<45 ml·min^-1·(1.73 m^2)^-1 and 45-59 ml·min^-1·(1.73 m^2)^-1 was 1.02(OR=2.02,95%CI:1.06~3.87)and 0.84(OR=1.84,95%CI:1.05-3.22)times higher than that of eGFR≥60 ml·min^-1·(1.73 m2)-1,respectively.Conclusion The incidence of frailty in the elderly patients with CKD is affected by many factors,such as age,body mass index and renal function,and increases with decreased renal function.