中国8个长寿地区65岁及以上老年人肾小球滤过率对全因死亡风险的影响

Effects of estimated glomerular filtration rate on all-cause mortality in the elderly aged 65 years and older in 8 longevity areas in China

目的探讨中国长寿地区≥65岁老年人估算肾小球滤过率(eGFR)与全因死亡率之间的关系。方法数据来源于"中国老年健康影响因素跟踪调查"子队列-"老年健康生物标志物队列研究",本研究共纳入2012年至2017/2018年的1802名研究对象。根据eGFR水平将老年人分为4组:肾功能中-重度损伤组[<45 ml·min-1·(1.73 m2)-1]、肾功能轻-中度损伤组[45~ml·min-1·(1.73 m2)-1]、肾功能轻度损伤组[60~ml·min-1·(1.73 m2)-1]、肾功能正常组[≥90 ml·min-1·(1.73 m2)-1]。采用Cox比例风险模型评估eGFR水平与死亡风险之间的关联。结果经6年随访共计852人死亡,死亡率为47.3%。多因素Cox回归分析结果显示,eGFR水平与老年人全因死亡风险呈负相关[eGFR水平每升高1 ml·min-1·(1.73 m2)-1,老年人死亡HR=0.993,95%CI:0.989~0.997,P=0.001];相较于肾功能正常组,肾功能中-重度损伤组、轻-中度损伤组及轻度损伤组老年人死亡HR值(95%CI)分别为1.690(1.224~2.332,P=0.001)、1.312(0.978~1.758,P=0.070)、1.349(1.047~1.737,P=0.020)(趋势检验P<0.001)。结论eGFR下降与中国长寿地区老年人群的高死亡风险相关。

Objective To investigate the association between estimated glomerular filtration rate(eGFR)and all-cause mortality in the elderly aged 65 years and older in longevity areas in China.Methods Data used in this study were obtained from Healthy Aging and Biomarkers Cohort Study,a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey,1802 elderly adults were collected in the study during 2012-2017/2018.In this study,the elderly were classified into 4 groups,moderate-to-severe group[<45 ml·min-1·(1.73 m2)-1],mild-to-moderate group[45-ml·min-1·(1.73 m2)-1],mild group[60-ml·min-1·(1.73 m2)-1]and normal group[≥90 ml·min-1·(1.73 m2)-1]according to their eGFR levels.Results After 6 years of follow-up,852 participants died,with a mortality rate of 47.3%.Multivariate Cox regression analysis showed that the levels of eGFR were negatively correlated with all-cause mortality risk in the elderly(the HR of elderly was 0.993 and the 95%CI was 0.989-0.997 for every unit of eGFR increased,P=0.001),while compared with the group with normal eGFR,the HRs(95%CI)of the elderly in the moderate-to-severe group,mild-to-moderate group,and mild group were 1.690(1.224-2.332,P=0.001),1.312(0.978-1.758,P=0.070),1.349(1.047-1.737,P=0.020)respectively[trend test P<0.001].Conclusion The decrease in eGFR was associated with higher mortality risk among the elderly in longevity areas in China.