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IF 6.7 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medical Journal of Australia Pub Date : 2024-12-17 DOI:10.5694/mja2.52559

Elisa K Bongetti, Rory Wolfe, James B Wetmore, Anne M Murray, Robyn L Woods, Michelle A Fravel, Mark R Nelson, Nigel P Stocks, Suzanne G Orchard, Kevan R Polkinghorne

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引用次数: 0

摘要

目的：评估从2009年CKD-EPI（CKD-EPI2009）公式改为2021年CKD-EPI（CKD-EPI2021）公式计算估计肾小球滤过率（eGFR）对一般健康的澳大利亚老年人的临床影响：对前瞻性 ASPirin in Reducing events in the Elderly (ASPREE) 队列研究数据的二次分析：2010年3月1日至2014年12月31日为ASPREE试验招募的70岁或70岁以上居住在社区、无限制性疾病的澳大利亚人：根据CKD-EPI2021和CKD-EPI2009划分为不同慢性肾脏病（CKD）分期的参与者，以及根据这两个公式划分为相同CKD分期的参与者的基线特征和长期健康结果：共有 16 244 名澳大利亚 ASPREE 试验参与者的完整数据。基线时，他们的平均年龄为 75.3 岁（标准差为 4.4 岁），8938 人为女性（55%）；eGFR 中位数（CKD-EPI2009）为 74 mL/min/1.73 m2（四分位数间距 [IQR]，64-85 mL/min/1.73 m2），尿白蛋白与肌酐比值中位数为 0.8 mg/mmol（IQR，0.大多数参与者的 eGFR 值在 CKD-EPI2021 中高于 CKD-EPI2009（中位数差异，3.8 mL/min/1.73 m2；IQR，3.3-4.4 mL/min/1.73 m2），3274 名参与者（20%）被 CKD-EPI2021 划分为较低的 CKD 阶段。在 CKD-EPI2009 中，eGFR 值低于 60 mL/min/1.73 m2（临床 CKD）的参与者比例为 17%（2770 人），在 CKD-EPI2021 中为 12%（1994 人）。参与者的随访时间中位数为 6.5 年（IQR，5.4-7.9 年）；达到无残疾生存复合终点（调整后危险比 [aHR]，0.94；95% 置信区间 [CI]，0.84-1.05）、全因死亡率（aHR，0.90；95% CI，0.78-1.03）、重大心脏事件（aHR，0.94；95% CI，0.79-1.13）和心力衰竭住院（aHR，1.00；95% CI，0.67-1.49）在通过 CKD-EPI2021 重新分类或未重新分类的参与者中均相似：结论：与 CKD-EPI2009 相比，使用 CKD-EPI2021 会得出更高的 eGFR 值，从而大幅降低被归类为 CKD 的澳大利亚老年人的比例，但被重新归类为 CKD 较低分期的人的长期健康结果却没有任何总体差异。使用 CKD-EPI2021 可以显著减少一般健康的老年人转诊到肾病专科的次数。

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Classification of chronic kidney disease in older Australian adults by the CKD-EPI 2009 and 2021 equations: secondary analysis of ASPREE study data.

Objectives: To assess the clinical impact on generally healthy older Australians of changing from the 2009 CKD-EPI (CKD-EPI₂₀₀₉) to the 2021 CKD-EPI (CKD-EPI₂₀₂₁) equation for calculating the estimated glomerular filtration rate (eGFR).

Study design: Secondary analysis of data from the prospective ASPirin in Reducing events in the Elderly (ASPREE) cohort study.

Setting, participants: Australians aged 70 years or older living in the community and without life-limiting medical conditions, recruited 1 March 2010 - 31 December 2014 for the ASPREE trial.

Main outcome measures: Baseline characteristics and long term health outcomes for participants classified to different chronic kidney disease (CKD) stages by CKD-EPI₂₀₂₁ and CKD-EPI₂₀₀₉, and for those classified to the same CKD stage by both equations.

Results: Complete data were available for 16 244 Australian ASPREE trial participants. At baseline, their mean age was 75.3 years (standard deviation, 4.4 years), and 8938 were women (55%); the median eGFR (CKD-EPI₂₀₀₉) was 74 mL/min/1.73 m² (interquartile range [IQR], 64-85 mL/min/1.73 m²), the median urine albumin-to-creatinine ratio 0.8 mg/mmol (IQR, 0.5-1.4 mg/mmol). eGFR values were higher for most participants with CKD-EPI₂₀₂₁ than with CKD-EPI₂₀₀₉ (median difference, 3.8 mL/min/1.73 m²; IQR, 3.3-4.4 mL/min/1.73 m²), and 3274 participants (20%) were classified to less advanced CKD stages by CKD-EPI₂₀₂₁. The proportion of participants with eGFR values below 60 mL/min/1.73 m² (clinical CKD) was 17% (2770 participants) with CKD-EPI₂₀₀₉ and 12% (1994 participants) with CKD-EPI₂₀₂₁. Participants were followed up at a median of 6.5 years (IQR, 5.4-7.9 years); the risks of reaching the disability-free survival composite endpoint (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.84-1.05), all-cause mortality (aHR, 0.90; 95% CI, 0.78-1.03), major cardiac events (aHR, 0.94; 95% CI, 0.79-1.13), and hospitalisations with heart failure (aHR, 1.00; 95% CI, 0.67-1.49) were each similar for participants reclassified or not reclassified by CKD-EPI₂₀₂₁.

Conclusions: Using CKD-EPI₂₀₂₁ would yield higher eGFR values than the CKD-EPI₂₀₀₉, substantially reducing the proportion of older Australian adults classified as having CKD, without any overall difference in long term health outcomes for people reclassified to less advanced CKD stages. Using the CKD-EPI₂₀₂₁ could markedly reduce the number of referrals of generally healthy older adults to specialist nephrology services.

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来源期刊

Medical Journal of Australia 医学-医学：内科

CiteScore

9.40

自引率

5.30%

发文量

410

审稿时长

3-8 weeks

期刊介绍： The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.