2012-2016年上海市长宁区老年人群慢性肾脏病患病率调查研究

Prevalence of Chronic Kidney Disease among the Elderly in Changning District of Shanghai from 2012 to 2016

背景长宁区委、区政府始终高度重视老龄工作,注重“幸福养老”,对65岁及以上老年人免费体检。慢性肾脏病(CKD)发展至终末期即尿毒症,透析和肾移植可以延长寿命,但是对于老年人群存在很多不便,极大地降低了其生活质量,增加了大量医疗成本。故在老年人群中及早发现CKD,在早中期及时干预治疗延缓CKD进展至尿毒症,意义重大。目的2012-2016年连续调查上海市长宁区老年人群CKD患病率,比较患病率情况。方法2012-2016年上海市长宁区参加健康体检的老年人群(≥65岁),2012年28361人,2013年23745人,2014年24864人,2015年25405人,2016年24584人。调查内容包括问卷调查(姓名、性别、出生日期、居住地等基本信息)、实验室检查项目(血肌酐、尿常规等),根据估算肾小球滤过率(e GFR)进行CKD分期。分析2012-2016年老年人群CKD患病率及各期构成,性别、年龄对CKD的影响采用非条件Logistic回归(逐步回归)分析。结果2012-2016年老年人群CKD患病率分别为16.22%(4601/28361)、15.13%(3592/23745)、14.54%(3614/24864)、9.81%(2493/25405)、12.39%(3047/24584)。2012-2016年老年人群CKD各期构成不同,差异有统计学意义(似然比为24700.47,P<0.001)。2012年、2014年、2016年老年人群正常与CKD患者性别构成比较,差异均有统计学意义(P<0.05)。2012-2016年老年人群CKD患者年龄大于正常者(P<0.05)。Logistic回归分析结果显示,2012-2016年老年人群中,女性CKD患病率分别是男性的1.536、1.426、1.392、1.351、1.509倍;年龄每增加1岁,CKD患病率分别是原来的1.103、1.104、1.100、1.104、1.103倍(P<0.05)。结论上海市长宁区老年人群CKD患病率较高,2012-2016年老年人群CKD患病率有下降趋势,但女性、老龄化增加老年人罹患CKD的风险。

Background The CPC Changning District Committee and the People's Government of Changning District have always attached great importance to the well-being of the elderly,with a focus on the support for happy aging.providing a free annual physical examination for adults aged 65 years and over.When the chronic kidney disease(CKD)develops to uremia,the final stage of CKD,although dialysis and kidney transplantation can prolong the life span,which also result in greatly reduced quality of life,and increased medical costs and other inconveniences.So it is of great significance to early detect CKD,and delay the progression of CKD to uremia by giving timely intervention in early or mid-term stage in this group.Objective To investigate and compare the prevalence of CKD in older adults from Shanghai's Changning District in 5 consecutive years(2012—2016).Methods Adults(≥65 years old)undergoing the free annual health check up in Changning District of Shanghai in 5 consecutive years were enrolled,including 28361 in 2012,23745 in 2013,24864 in 2014,25405 in 2015,and 24584 in 2016.They received a survey covering general demographic data(name,sex,date of birth,place of residence and other information),laboratory markers(serum creatinine,routine urinalysis results,etc.),and stage of CKD based on estimated glomerular filtration rate(eGFR).Annual prevalence of CKD and percentages of CKD stages 1-5 were compared.Unconditional Logistic regression(stepwise regression)was used to ermine the associations of sex and age with CKD.Results The prevalence of CKD during 2012—2016 was 16.22%(4601/28361),15.13%(3592/23745),14.54%(3614/24864),9.81%(2493/25405)and 12.39%(3047/24584),respectively.Annual CKD stages distribution differed significantly during this period(LR=24700.47,P<0.001).Sex ratio varied obviously between those with CKD and those without in 2012,2014 and 2016(P<0.05).CKD adults had greater mean age than non-CKD adults in each year of this period(P<0.05).Logistic regression analysis found that the prevalence of CKD in females was 1.536,1.426,1.392,1.351 and 1.509 times higher than that in males from 2012 to 2016,respectively.The prevalence of CKD grew by 1.103,1.104,1.100,1.104 and 1.103 times,respectively,for every additional year of age from 2012 to 2016(P<0.05).Conclusion The prevalence of CKD in older adults from Shanghai's Changning District was high during the period.Although the 5-year annul prevalence showed a downward trend,female and older age are associated with higher risk of CKD.