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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-1138

摘要内容如下：

背景

定义慢性肾脏病（CKD）的肾小球滤过率（GFR）的公认阈值是小于60ml/min/1.73m2。该阈值部分基于估计的肾小球滤过率（EGFR）与不良结局发生频率之间的相关性。这种关联在老年人中较弱，这就产生了关于这些人的阈值是否合适的分歧。此外，测量这些相关性的研究包括相对较少的结果和基于肌酐水平（eGFRcr）估计的GFR，这在老年人中可能不太准确。

客观

基于肌酐和胱抑素C水平（EGFRCR-Cys）评估老年人中EGFRCR与EGFR之间的相关性以及8种结果。

设计

基于人群的队列研究。

设置

2010年至2019年，瑞典斯德哥尔摩。

参与者

82154名年龄在65岁或以上的参与者接受了门诊肌酐和胱抑素C检测。

测量

全因死亡率、心血管死亡率和肾衰竭替代治疗（KFRT）的风险比；复发性住院、感染、心肌梗死或中风、心力衰竭和急性肾损伤的发病率比率。

结果

EGFRCR-Cys与结果之间的关联是单调的，但大多数EGFRCR的关联是U型的。此外，与EGFRCR相比，EGFRCR-Cys与预后的相关性更强。例如，60和80 mL/min/1.73 m2全因死亡率的校正风险比分别为1.2（95%CI，1.1至1.3）（EGFRCR-Cys）和1.0（CI，0.9至1.0）（EGFRCR），以及2.6（CI，1.2至5.8）和1.4（CI，0.7至2.8）（KFRT）。在亚组中观察到类似的结果，包括尿白蛋白-肌酐比值低于30 mg/G的患者。

局限性

无肾小球滤过率测量值。

结论

在老年患者中，与低eGFRcr相比，低eGFRcr-Cys与不良预后的相关性更强，且相关性更一致。

主要资金来源

瑞典研究委员会、美国国立卫生研究院和荷兰肾脏基金会。

英文原文如下：

Abstracts

BACKGROUND  The commonly accepted threshold of glomerular filtration rate (GFR) to define chronic kidney disease (CKD) is less than 60 mL/min/1.73 m2. This threshold is based partly on associations between estimated GFR (eGFR) and the frequency of adverse outcomes. The association is weaker in older adults, which has created disagreement about the appropriateness of the threshold for these persons. In addition, the studies measuring these associations included relatively few outcomes and estimated GFR on the basis of creatinine level (eGFRcr), which may be less accurate in older adults.

OBJECTIVE  To evaluate associations in older adults between eGFRcr versus eGFR based on creatinine and cystatin C levels (eGFRcr-cys) and 8 outcomes.

DESIGN  Population-based cohort study.

SETTING  Stockholm, Sweden, 2010 to 2019.

PARTICIPANTS  82 154 participants aged 65 years or older with outpatient creatinine and cystatin C testing.

MEASUREMENTS  Hazard ratios for all-cause mortality, cardiovascular mortality, and kidney failure with replacement therapy (KFRT); incidence rate ratios for recurrent hospitalizations, infection, myocardial infarction or stroke, heart failure, and acute kidney injury.

RESULTS  The associations between eGFRcr-cys and outcomes were monotonic, but most associations for eGFRcr were U-shaped. In addition, eGFRcr-cys was more strongly associated with outcomes than eGFRcr. For example, the adjusted hazard ratios for 60 versus 80 mL/min/1.73 m2 for all-cause mortality were 1.2 (95% CI, 1.1 to 1.3) for eGFRcr-cys and 1.0 (CI, 0.9 to 1.0) for eGFRcr, and for KFRT they were 2.6 (CI, 1.2 to 5.8) and 1.4 (CI, 0.7 to 2.8), respectively. Similar findings were observed in subgroups, including those with a urinary albumin-creatinine ratio below 30 mg/g.

LIMITATION  No GFR measurements.

CONCLUSION  Compared with low eGFRcr in older patients, low eGFRcr-cys was more strongly associated with adverse outcomes and the associations were more uniform.

PRIMARY FUNDING SOURCE  Swedish Research Council, National Institutes of Health, and Dutch Kidney Foundation.

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