增龄过程中慢性病对慢性肾脏病发生风险的影响  

Effect of comorbidities on the risk of chronic kidney disease with aging

作　　者：朱思珠 魏璐 沈雪 赵卫红 Zhu Sizhu;Wei Lu;Shen Xue;Zhao Weihong(Division of Nephrology,Department of Geriatric,the First Affiliated Hospital of Nanjing MedicalUniversity,Nanjing210029,China)

机构地区：[1]南京医科大学第一附属医院老年肾科,南京210029

出　　处：《中华老年医学杂志》2022年第9期1071-1075,共5页Chinese Journal of Geriatrics

基　　金：国家重点研发计划(2018YFC2002100、2018YFC2002102);国家自然科学基金面上项目(82171585);江苏省干部保健课题(BJ17018);江苏省人民医院511工程(JSPH-511A-2018-5)。

摘　　要：目的探讨增龄过程中慢性病对慢性肾脏病发生风险的影响。方法选取2018年1月至2020年1月在南京医科大学第一附属医院健康管理中心体检的103682例受试者进行回顾性横断面研究。依年龄分成4组:18~44、45~59、60~74、≥75岁组,各组分别为55055例、31023例、12793例和4811例,分析比较各年龄段及不同慢性病人群中表现为肾功能减退的慢性肾脏病[肾小球滤过率(eGFR)<60ml·min^(-1)·1.73m^(-2)]的检出率,并采用Logistic回归分析不同年龄段慢性病对肾功能减退的影响。结果血压、体质指数、血清肌酐、eGFR、血脂等指标及高血压、糖尿病、肥胖和共病的患病率均随增龄发生变化。总人群及各慢性病亚组中,肾功能减退的检出率均随增龄而增加,且在≥75岁组中大幅增多。校正年龄及性别后,45~59岁组人群中,单纯高血压及单纯糖尿病可显著增加肾功能减退的发生风险(OR=9.163、95%CI:3.264~25.727;OR=4.640、95%CI:1.028~20.936),共病人群肾功能减退的发生风险较单病增加,以高血压+糖尿病及三病共存为甚(OR=16.441、95%CI:5.325~50.783;OR=15.985,95%CI:4.237~60.312);60~74岁组人群中,单纯高血压也可显著增加肾功能减退的发生风险(OR=3.950,95%CI:1.911~8.165),共病中,对其发生风险影响最大的是三病共存(OR=6.245,95%CI:2.521~15.468),其次为高血压+肥胖(OR=5.640,95%CI:2.550~12.476)、高血压+糖尿病(OR=4.330,95%CI:1.990~9.421);≥75岁组中,慢性病及共病与肾功能减退发生的高风险相关,其中以单纯肥胖及高血压+肥胖风险最高(OR=6.746,95%CI:2.193~20.757;OR=6.570,95%CI:3.178~13.582),其次为三病共存(OR=4.749,95%CI:2.110~10.687)。结论高血压、糖尿病、肥胖的患病率随增龄变化,慢性病对老年人群肾功能减退的慢性肾脏病发生风险的影响与非老年人群存在差异。Objective To explore the effect of comorbidities on the risk of chronic kidney disease with aging.Methods..A total of 103682 subjects were recruited at the health management center of the First Affiliated Hospital of Nanjing Medical University from January 2018 to January 2020 for a retrospective cross-sectional study.Participants were divided into four groups according to age 18-44(55055 case),45-59(31023 case),60-74(12793 case),≥75(4811 case)age group.We calculated and compared the prevalences of estimated glomerular filtration rate(eGFR)<60 ml/min/1.73m,which was used as a parameter for kidney dysfunction,indifferent age groups and participants with different comorbidities.The association between comorbidities and the prevalence of kidney dysfunction was analyzed by Logistic regression.ResultsLevels of blood pressure,body mass index,serum creatinine,eGFR and blood lipids varied with aging,as did the prevalences of hypertension,diabetes,obesity and comorbidities.In all participants and groups based on the types of chronic diseases,the prevalence of kidney dysfunction increased with aging,substantially so in≥75 age group.After adjustment for age and sex,there was a marked increase in the risk of kidney dysfunction in 45-59 age group adults with hypertension or diabetes(OR=9.163,95%CI:3.264-25.727;OR=4.640,95%CI:1.028-20.936),and the risk of renal dysfunction increased in people with hypertension+diabetes or with the coexistence of three diseases,compared with people with a single disease(OR=16.441,95%CI:5.325-50.783;OR=15.985,95%CI:4.237-60.312);In the 60-74 age group,hypertension alone also significantly increased the risk of renal dysfunction(OR=3.950,95%CI:1.911-8.165).With comorbidities,the most significant influence was the coexistence of three diseases(OR=6.245,95%CI:2.521-15.468),followed by hypertension+obesity(OR=5.640,95%CI:2.550-12.476)and hypertension+diabetes(OR=4.330,95%CI:1.990-9.421);In≥75 age group,chronic diseases and comorbidities were associated with a high risk of renal dysfunction,wit

关 键 词：慢性病 增龄 肾疾病 

分 类 号：R692[医药卫生—泌尿科学]