摘要
目的研究85岁及以上高龄患者临终时肾脏功能状态及特点。方法回顾性选取2016年1月至2018年2月在首都医科大学附属北京友谊医院内科系统住院死亡的85岁及以上高龄患者共159例作为研究对象(高龄组),以同期年龄为18~64岁的死亡成年患者60例作为对照(成年组),分析合并症、死因构成、基础及临终时肾脏功能状态。结果高龄组共病的患病率高达90.6%,显著高于成年组(P<0.01),高龄组患者第1位死亡原因为感染性疾病(59.1%)。高龄组慢性肾脏病(CKD)患病率达50.3%;急性肾损伤(AKI)患病率为52.8%,其中在CKD基础上发生的AKI占59.5%,CKD及在CKD基础上发生的AKI的患病率显著高于成年组(P<0.01)。高龄组患者基础时及临终前的估算肾小球滤过率(e GFR)显著低于成年组(P<0.01),而基础时及临终前血肌酐在两组间差异无统计学意义(P>0.05)。结论高龄内科住院患者CKD患病率和临终时AKI发生率高;采用血肌酐结合e GFR水平能更准确地评估肾脏功能状态。
Objective To analyze the characteristic of renal function in the oldest-old patients（ 85 years and over） before the end of life. Methods A retrospective study of 159 oldest-old patients（ elderly group） who died in the department of internal medicine of Beijing Friendship Hospital affiliated to Capital Medical University from January 2016 to February 2018 was conducted. 60 adult patients（ 18-64 years）who died in the same period were enrolled as control group（ adult group）. All the renal function,causes of death and the complications were recorded according to the medical records. Results Morbidity of multiple chronic conditions in elderly group was 90. 6%,significantly higher than that of adult group（ P〈0. 01）. The first causes of death was infectious diseases（ 59. 1%）. In the elderly group,the morbidity of chronic kidney disease was 50. 3%. 52. 8% of the elderly group patients developed AKI,among them 59. 5% were acute on chronic kidney disease. The morbidity of chronic kidney disease and acute on chronic kidney disease in elderly group were significantly higher than those of adult group（ P〈0. 01）.Either the baseline e GFR or the e GFR before dying were significantly decreased in the elderly group（ P〈0. 01）,but there was no difference of serum creatinine between two groups. Conclusion Morbidity of multiple chronic conditions in elderly patients is high. Renal function impairment is more common in the elderly patients. In elderly patients,it will be more accurate to assess the renal function by serum creatinine levels and e GFR together.
作者
姚兰
马清
杨华昱
陈海平
YAO Lan;MA Qing;YANG Hua-yu(Division of Geriatric Nephrology,Medical and Health Care Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China.)
出处
《临床和实验医学杂志》
2018年第15期1670-1673,共4页
Journal of Clinical and Experimental Medicine
基金
北京市科委首都市民健康项目培育(编号:Z151100003915098)
关键词
高龄
慢性肾脏病
急性肾损伤
死亡原因
Aging
Chronic kidney disease
Acute kidney injury
Death causes
