年龄对2~4期慢性肾脏病患者肾脏结局的影响

The influence of age on renal outcomes in patients with stage 2-4 chronic kidney disease

目的评估2~4期慢性肾脏病(CKD)患者的年龄和肾脏结局的相关性及不同病因的肾脏疾病中年龄对CKD结局的影响。方法前瞻性队列研究纳入470例2~4期CKD患者。采用Kaplan-Meier方法分析不同年龄组间CKD结局的差异。多变量Cox回归模型分析CKD进展的独立危险因素。采用倾向评分匹配(PSM)调整两个年龄组CKD结局危险因素的基线差异。结果470例患者中,观察到39例终末期肾病(ESRD)事件(均开始透析)和51例死亡事件。Kaplan-Meier生存曲线(P=0.039)及Cox回归单因素生存分析(P=0.043)均显示,<60岁是CKD患者进展为ESRD的危险因素。在多因素Cox回归中,年龄仍然是CKD患者进展的独立危险因素(危险比0.386,95%CI:0.163~0.916;P=0.031)。对于不同病因的肾脏疾病,高血压肾损害(P=0.024)及原发性肾小球肾炎(P=0.047)患者中,<60岁患者的ESRD累积发病率高于≥60岁患者。<60岁和≥60岁患者的全因死亡率差异无统计学意义(P=0.646)。结论2~4期CKD的老年患者的ESRD风险低于年轻患者。这一发现有助于肾科医生和决策者优化老年CKD患者的管理。

Objective To evaluate the correlation between age and renal outcomes in patients with stage 2-4 chronic kidney disease(CKD)and the impact of age on CKD outcomes in kidney diseases of different etiologies.Methods A prospective cohort study included 470 patients with stage 2-4 CKD.The Kaplan Meier method was used to analyze the differences in CKD outcomes among different age groups.The independent risk factors for CKD progression were analyzed using a multivariate Cox regression model.We adjusted for baseline differences in risk factors for CKD outcomes between two age groups using propensity score matching(PSM).Results Among 470 patients,39 cases of end-stage renal disease(ESRD)events(all starting dialysis)and 51 deaths were observed.The Kaplan Meier survival curve(P=0.039)and Cox regression univariate survival analysis(P=0.043)both showed that<60 years old is a risk factor for CKD patients to progress to ESRD.In multivariate Cox regression,age remained an independent risk factor for the progression of CKD patients(hazard ratio 0.386,95%CI:0.163-0.916;P=0.031).For kidney diseases with different causes,in patients with hypertensive kidney damage(P=0.024)and primary glomerulonephritis(P=0.047),the cumulative incidence rate of ESRD in patients<60 years old was higher than that in patients≥60 years old.There was no statistically significant difference in all-cause mortality rates between patients aged<60 and≥60 years old(P=0.646).Conclusions Elderly patients with stage 2-4 CKD have a lower ESRD risk than younger patients.This discovery helps nephrologists and decision-makers optimize the management of elderly CKD patients.