PDF(Pubmed)
Abstract：
UNASSIGNED: The risk implications of the Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease classification in older adults are controversial. We evaluated the risk of adverse outcomes in this population across categories of estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR).
UNASSIGNED: Prospective cohort.
UNASSIGNED: In total, 2,509 participants aged ≥75 years in the Systolic Blood Pressure Intervention Trial (SPRINT).
UNASSIGNED: KDIGO eGFR and UACR categories. We combined KDIGO categories G1 and G2, G3b and G4, as well as A2 and A3.
UNASSIGNED: Primary SPRINT outcome (composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), and all-cause death.
UNASSIGNED: Multivariable Cox proportional hazard models.
UNASSIGNED: Mean age was 79.8 years, and 37.4% were female. The mean eGFR was 64.0 mL/min/1.73 m2, and the median UACR was 13.1 mg/g. In multivariable Cox proportional hazard analysis, compared with participants with eGFR ≥ 60 mL/min/1.73 m2 and UACR < 30 mg/g, there was no statistically significant difference in the risk of the primary outcome among participants with eGFR 45-59 or 15-44 mL/min/1.73 m2 and UACR < 30 mg/g. However, those with eGFR 45-59 or 15-44 mL/min/1.73 m2 and UACR ≥ 30 mg/g had higher risk of the primary outcome (HR [95% CI], 1.97 [1.27-3.04] and 3.32 [2.23-4.93], respectively). The risk for all-cause death was higher for each category of abnormal eGFR and UACR, with the highest risk observed among those with eGFR 15-44 mL/min/1.73 m2 and UACR ≥ 30 mg/g (3.34 [2.05-5.44]).
UNASSIGNED: Individuals with diabetes and urine protein >1 g/day were excluded from SPRINT.
UNASSIGNED: Among older adults SPRINT participants, low eGFR without albuminuria was associated with higher mortality but not with increased risk of cardiovascular events. Additional studies are needed to evaluate an adapted chronic kidney disease stage-based risk stratification for older adults.
Using data from participants in the SPRINT trial, we evaluated the association of chronic kidney disease stage with adverse clinical outcomes among adults older than 75 years without diabetes. We found that low level of kidney function determined by a low estimated glomerular filtration rate with moderately or severely increased urine albumin excretion was associated with increased risk for cardiovascular events and all-cause mortality. However, low estimated glomerular filtration rate with normal or mildly increased urinary albumin excretion was not consistently associated with these adverse outcomes. This finding supports the need for additional studies to evaluate an age-adapted classification of chronic kidney disease to improve risk stratification among older adults.
UNASSIGNED: Prospective cohort.
UNASSIGNED: In total, 2,509 participants aged ≥75 years in the Systolic Blood Pressure Intervention Trial (SPRINT).
UNASSIGNED: KDIGO eGFR and UACR categories. We combined KDIGO categories G1 and G2, G3b and G4, as well as A2 and A3.
UNASSIGNED: Primary SPRINT outcome (composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), and all-cause death.
UNASSIGNED: Multivariable Cox proportional hazard models.
UNASSIGNED: Mean age was 79.8 years, and 37.4% were female. The mean eGFR was 64.0 mL/min/1.73 m2, and the median UACR was 13.1 mg/g. In multivariable Cox proportional hazard analysis, compared with participants with eGFR ≥ 60 mL/min/1.73 m2 and UACR < 30 mg/g, there was no statistically significant difference in the risk of the primary outcome among participants with eGFR 45-59 or 15-44 mL/min/1.73 m2 and UACR < 30 mg/g. However, those with eGFR 45-59 or 15-44 mL/min/1.73 m2 and UACR ≥ 30 mg/g had higher risk of the primary outcome (HR [95% CI], 1.97 [1.27-3.04] and 3.32 [2.23-4.93], respectively). The risk for all-cause death was higher for each category of abnormal eGFR and UACR, with the highest risk observed among those with eGFR 15-44 mL/min/1.73 m2 and UACR ≥ 30 mg/g (3.34 [2.05-5.44]).
UNASSIGNED: Individuals with diabetes and urine protein >1 g/day were excluded from SPRINT.
UNASSIGNED: Among older adults SPRINT participants, low eGFR without albuminuria was associated with higher mortality but not with increased risk of cardiovascular events. Additional studies are needed to evaluate an adapted chronic kidney disease stage-based risk stratification for older adults.
Using data from participants in the SPRINT trial, we evaluated the association of chronic kidney disease stage with adverse clinical outcomes among adults older than 75 years without diabetes. We found that low level of kidney function determined by a low estimated glomerular filtration rate with moderately or severely increased urine albumin excretion was associated with increased risk for cardiovascular events and all-cause mortality. However, low estimated glomerular filtration rate with normal or mildly increased urinary albumin excretion was not consistently associated with these adverse outcomes. This finding supports the need for additional studies to evaluate an age-adapted classification of chronic kidney disease to improve risk stratification among older adults.
摘要：
■肾脏疾病的风险影响：改善老年人的全球结果（KDIGO）慢性肾脏疾病分类存在争议。我们通过估算的肾小球滤过率（eGFR）和尿白蛋白-肌酐比（UACR）类别评估了该人群的不良结局风险。
■前瞻性队列。
■总共，2,509名年龄≥75岁的参与者参加了收缩压干预试验（SPRINT）。
■KDIGOeGFR和UACR类别。我们结合了KDIGO类别G1和G2，G3b和G4，以及A2和A3。
■主要SPRINT结果（复合心肌梗死，其他急性冠脉综合征,中风,心力衰竭,或因心血管原因死亡)，和全因死亡。
■多变量Cox比例风险模型。
■平均年龄为79.8岁，37.4%为女性。平均eGFR为64.0mL/min/1.73m2，中位UACR为13.1mg/g。在多变量Cox比例风险分析中，与eGFR≥60mL/min/1.73m2和UACR<30mg/g的参与者相比，eGFR为45~59或15~44mL/min/1.73m2且UACR<30mg/g的参与者的主要结局风险无统计学差异.然而,eGFR为45-59或15-44mL/min/1.73m2且UACR≥30mg/g的患者具有较高的主要结局风险（HR[95％CI]，1.97[1.27-3.04]和3.32[2.23-4.93]，分别)。eGFR和UACR各异常类别的全因死亡风险较高，在eGFR为15-44mL/min/1.73m2且UACR≥30mg/g（3.34[2.05-5.44]）的人群中，风险最高。
■患有糖尿病和尿蛋白>1g/天的个体从SPRINT中排除。
■在老年人SPRINT参与者中，无蛋白尿的低eGFR与较高的死亡率相关,但与心血管事件风险增加无关.需要更多的研究来评估老年人适应的基于慢性肾脏疾病阶段的风险分层。
使用SPRINT试验参与者的数据，我们在75岁以上无糖尿病的成人中评估了慢性肾脏病分期与不良临床结局的关系.我们发现，由低估计肾小球滤过率和中度或重度尿白蛋白排泄增加决定的低水平肾功能与心血管事件和全因死亡率的风险增加相关。然而,低估计肾小球滤过率和正常或轻度增加的尿白蛋白排泄与这些不良结局并不一致.这一发现支持了需要更多的研究来评估慢性肾脏疾病的年龄适应分类，以改善老年人的风险分层。
■前瞻性队列。
■总共，2,509名年龄≥75岁的参与者参加了收缩压干预试验（SPRINT）。
■KDIGOeGFR和UACR类别。我们结合了KDIGO类别G1和G2，G3b和G4，以及A2和A3。
■主要SPRINT结果（复合心肌梗死，其他急性冠脉综合征,中风,心力衰竭,或因心血管原因死亡)，和全因死亡。
■多变量Cox比例风险模型。
■平均年龄为79.8岁，37.4%为女性。平均eGFR为64.0mL/min/1.73m2，中位UACR为13.1mg/g。在多变量Cox比例风险分析中，与eGFR≥60mL/min/1.73m2和UACR<30mg/g的参与者相比，eGFR为45~59或15~44mL/min/1.73m2且UACR<30mg/g的参与者的主要结局风险无统计学差异.然而,eGFR为45-59或15-44mL/min/1.73m2且UACR≥30mg/g的患者具有较高的主要结局风险（HR[95％CI]，1.97[1.27-3.04]和3.32[2.23-4.93]，分别)。eGFR和UACR各异常类别的全因死亡风险较高，在eGFR为15-44mL/min/1.73m2且UACR≥30mg/g（3.34[2.05-5.44]）的人群中，风险最高。
■患有糖尿病和尿蛋白>1g/天的个体从SPRINT中排除。
■在老年人SPRINT参与者中，无蛋白尿的低eGFR与较高的死亡率相关,但与心血管事件风险增加无关.需要更多的研究来评估老年人适应的基于慢性肾脏疾病阶段的风险分层。
使用SPRINT试验参与者的数据，我们在75岁以上无糖尿病的成人中评估了慢性肾脏病分期与不良临床结局的关系.我们发现，由低估计肾小球滤过率和中度或重度尿白蛋白排泄增加决定的低水平肾功能与心血管事件和全因死亡率的风险增加相关。然而,低估计肾小球滤过率和正常或轻度增加的尿白蛋白排泄与这些不良结局并不一致.这一发现支持了需要更多的研究来评估慢性肾脏疾病的年龄适应分类，以改善老年人的风险分层。
