老年人群高血压与慢性肾脏病关系的回顾性队列研究

Retrospective cohort study on the relationship between hypertension and chronic kidney disease in the elderly

摘要:

目的 分析65岁及以上老年人群高血压动态变化对慢性肾炎病（chronic kidney disease,CKD）发病的影响。方法 采用回顾性队列研究，将我院门诊部2015年3月至2018年9月确诊为高血压患者无其他器质性疾病患者419例作为暴露组，同期因其他疾病就医非高血压患者作为对照组。2020年12月收集整理队列内具有完整临床数据的患者，终纳入患者269例。采集信息包括性别、年龄、血压、24h尿蛋白及血肌酐等。依据血肌酐水平估算患者肾小球滤过率进行CKD分期（1-5期），依据舒张压、收缩压水平将患者区分为高血压轻度、中度、高度三级，比较两组老年人群CKD发病结局。结果 经过中位时间3.50年的追踪随访，65岁及以上老年群体新发CKD患者53例，累计发病率19.70%，发病密度56.71/1 000人年（95%CI:53.29~59.83)。COX回归结果显示，老年群体高血压水平与CKD发病风险呈正相关(HR>1)；同时，CKD发病风险随着血压分期而增加。进行性别、年龄等因子分层后，高血压与慢性肾病发生仍呈显著正相关。此外，老年男性高血压对慢性肾病发生影响显著高于女性。结论 我国老年人群尤其男性高血压改变与慢性肾病进展具有显著相关性，需重视老年群体血压控制延缓CKD进展。

Abstract:

Objective To analyze the effect of dynamic changes of hypertension on the incidence of chronic kidney disease (CKD) in the elderly aged 65 and over. Methods A retrospective cohort study was conducted. A total of 419 patients with hypertension without other organic diseases diagnosed in the outpatient department of our hospital from March 2015 to September 2018 were used as the exposure group, and non-hypertensive patients with other diseases in the same period were used as the control group. In December 2020, 269 patients with complete clinical data in the cohort were finally included. The collected information includes gender, age, blood pressure, 24-hour urinary protein and blood creatinine. According to the level of serum creatinine, the glomerular filtration rate of patients was estimated for CKD stage (stage 1-5). According to the level of diastolic blood pressure and systolic blood pressure, patients were divided into mild, moderate and high levels of hypertension. The incidence and outcome of CKD in the two groups were compared. Results After median follow-up of 3.50 years , 53 cases of new CKD patients aged 65 and above were found. The cumulative incidence rate was 19.70%, and the incidence density was 56.71/1 000 years (95% CI: 53.29 - 59.83 ). Cox regression showed that the level of hypertension in the elderly was positively correlated with the risk of CKD (HR > 1); At the same time, the risk of CKD increased with the stage of blood pressure. After stratified by gender, age and other factors, there was still a significant positive correlation between hypertension and chronic kidney disease. In addition, the effect of hypertension on chronic kidney disease in elderly men was significantly higher than that in women. Conclusion There is a significant correlation between the changes of hypertension and the progress of chronic kidney disease in the elderly population, especially men. We should pay attention to the control of blood pressure in the elderly population and delay the progress of CKD.