基于不同评价方法的布依族地区农村老年人肾功能状况比较分析

Comparative analysis of the prevalence of renal function decline defined by three CKD-EPI equations among the elderly in rural bouyel areas of Guizhou

目的比较基于血清肌酐、胱抑素C及两者联合的CKD-EPI(chronic kidney disease epidemiology collaboration)方程评估布依族农村老年人肾功能下降的流行情况及影响因素的差异。方法采用横断面研究设计,对贵州省布依族农村地区1235名>60岁以上老年人进行问卷调查,并采集空腹静脉血检测血清肌酐,胱抑素C及相关生化指标,使用三个CKD-EPI方程评估肾功能下降的患病率,采用logistic逐步回归法分析肾功能下降的影响因素。结果三种方法计算1235名老年人的肾功能下降的患病率分别为10.52%(CKD-EPIscr)、32.30%(CKD-EPIcysc)、14.57%(CKD-EPIscr-cysc)。使用CKD-EPIcys方程评估肾功能下降时,女性患病率高于男性(35.11%vs.28.51%,χ^(2)=6.020,P=0.014),且随年龄增加而增加(χ^(2)_(趋势)=45.281,P<0.01);高龄(OR=4.07,95%CI:2.73~6.08)、布依族(OR=2.08,95%CI:1.60~2.69)、高血压(OR=1.41,95%CI:1.09~1.82)、血脂异常(OR=1.52,95%CI:1.13~2.04)是老年人肾功能下降的危险因素。使用CKD-EPIscr-cys方程评估肾功能下降时,女性患病率高于男性(17.20%vs.11.97%,χ^(2)=6.486,P=0.011),且随年龄增加而增加(χ^(2)_(趋势)=89.704,P<0.01);高龄(OR=8.74,95%CI:5.41~14.11)、布依族(OR=2.05,95%CI:1.45~3.23)、高血压(OR=2.06,95%CI:1.47~2.88)、血脂异常(OR=1.67,95%CI:1.14~2.44)是老年人肾功能下降的危险因素。结论基于血清肌酐、胱抑素C及两者联合的三种CKD-EPI方程评估社区老年人肾功能下降的患病率存在差异,CKD-EPIcysc和CKD-EPIscr-cysc方程评价肾功能下降的影响因素较一致,老年人肾小球滤过率最合适的评价方法仍需进一步研究。

Objective To compare the prevalence of renal function decline assessed by three chronic kidney disease epidemiology collaboration(CKD-EPI)equations bases on serum creatinine alone,cystatin C alone or both among the elderly in rural bouyel areas of Guizhou,and to discuss the influencing factors under each equation assessment.Methods A questionnaire survey was conducted among 1235 older residents aged over 60 years selected using multi-stage cluster sampling method from rural bouyel areas of Guizhou Province.Blood samples were collected and serum levels of creatinine,cystatin C and other related biomarkers were determined.The prevalence of renal function decline[eGFR<60 ml/(min·1.73 m^(2))]was calculated using the above three different equations.Logistic step-wide regression was?performed to analyze risk factors.Results The prevalence of renal function decline in 1235 elderly residents were 10.52%(CKD-EPIscr),32.30%(CKD-EPIcysc)and 14.57%(CKD-EPIscr-cysc),respectively.When the CKD-EPIcys equation was used,the prevalence was higher in women than in men(35.11%vs.28.11%,χ^(2)=6.020,P=0.014),and increased with age(χ^(2)trend value=45.281,P<0.01).Older age(OR=4.07,95%CI:2.73-6.08),the bouyel nationality(OR=2.08,95%CI:1.60-2.69),hypertension(OR=1.41,95%CI:1.09-1.82),dyslipidemia(OR=1.52,95%CI:1.13-2.04)were risk factors for reduced renal function in the elderly.When the CKD-EPIscr-cys equation was used,the prevalence was also higher in women than in men(17.20%vs.11.97%,χ^(2)=6.486,P=0.011),and increased with age(χ^(2)trend value=89.704,P<0.01).Older age(OR=8.74,95%CI:5.41-14.11),the bouyel nationality(OR=2.05,95%CI:1.45-3.23),hypertension(OR=2.06,95%CI:1.47-2.88),dyslipidemia(OR=1.67,95%CI:1.14-2.44)were found to be major risk factors for reduced renal function in the elderly.Conclusions The differences in the prevalence of renal function decline assessed using the CKD-EPI equation based on serum creatinine,cystatin C or both are significant among the elderly,while the influencing factors for the renal function decline are similar under CKD-EPIcysc and CKD-EPIscr-cys equations.More studies need to be done to find the most suitable method to assess renal function in the elderly.