衰弱对老年慢性肾脏病患者预后的影响分析  

Analysis of the Influence of Weakness on the Prognosis of Senile Chronic Kidney Disease Patients

作　　者：汪澈 郭辛茹 王文苓 梁爽 吴杰 张利 孙雪峰 陈香美 蔡广研 WANG Che;GUO Xinru;WANG Wenling(Department of Nephrology,the First Medical Center,Chinese PLA General Hospital,Beijing,100853)

机构地区：[1]中国人民解放军总医院第一医学中心肾脏病医学部,中国人民解放军肾脏病研究所,肾脏疾病国家重点实验室,国家慢性肾病临床医学研究中心,肾脏疾病研究北京市重点实验室,北京100853

出　　处：《中国中西医结合肾病杂志》2022年第2期112-117,共6页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家重点研发计划项目(No.2018YFA0108803);北京市科技计划项目(No.D181100000118004)。

摘　　要：目的:探究衰弱对老年慢性肾脏病患者预后的影响。方法:选取中国人民解放军总医院第一医学中心肾内科2017年10月—2019年04月间住院治疗的老年CKD患者,以衰弱指数(FI)评估其衰弱状况,依据FI值将患者分为低、中、高FI组,采用Kaplan-Meier生存分析三组患者的累积无CKD复合结局生存率,多因素Cox比例风险回归模型分析导致死亡和肾脏终点的危险因素。结果:研究共纳入老年CKD患者193例,其中男124(64.6%)例,中位年龄64岁,平均eGFR 61.5 ml·min^(-1)·1.73 m^(-2),经过36.5个月的中位随访时间,46(23.8%)例患者到达复合终点,低、中、高FI组之间累积无CKD复合结局生存率差异有统计学意义(Log-rank检验χ^(2)=9.981,P=0.007)。FI、基线CKD 4期与复合结局、肾脏终点的发生独立相关(HR=1.05,95%CI 1.02~1.09,P=0.003;HR=7.82,95%CI 2.59~23.55,P<0.001;HR=1.05,95%CI 1.00~1.10,P=0.035;HR=14.21,95%CI 3.21~63.00,P<0.001)。结论:衰弱增加老年CKD患者死亡和肾脏终点的发生风险。Objective:To investigate the prognostic impact of frailty in elderly patients with chronic kidney disease(CKD).Methods:A cohort study was carried out among elderly CKD patients who received inpatient care in the department of nephrology at the First Medical Center of the Chinese PLA General Hospital from Oct 2017 to Apr 2019.A frailty index was used to assess the frailty status of the included CKD patients.Patients were divided into 3 groups:low FI group,median FI group,and high FI group according to FI score.The mortality and CKD progression rates were compared between three groups.Kaplan-Meier survival analysis was used to calculate the CKD composite outcome-free survival probability.Cox regression analysis was used to find out the risk factors for mortality and CKD progression.Results:A total of 193 patients(median age 64 years,64.6%males)were included in this study with an average eGFR of 61.5 ml/min per 1.73 m^(2).During the median follow-up of 36.5 months,46 patients(23.8%)had a composite outcome.The time functions for FI predicting CKD composite outcome-free survival probability were significantly different(Log-rankχ^(2)=9.981,P=0.007).The patients with the highest FI group were more likely to have poor prognoses during follow-up.FIs and baseline CKD stageⅣwere independently associated with CKD composite outcomes(death or CKD progression)and CKD progression in elderly patients with CKD(HR=1.05,95%CI 1.02~1.09,P=0.003;HR=7.82,95%CI 2.59~23.55,P<0.001;HR=1.05,95%CI 1.00~1.10,P=0.035;HR=14.21,95%CI 3.21~63.00,P<0.001).Conclusion:Frailty was associated with increased risk of CKD composite outcomes(death or CKD progression)among elderly patients with CKD.

关 键 词：慢性肾脏病 衰弱 衰弱指数 死亡 肾脏终点 

分 类 号：R692[医药卫生—泌尿科学]