Predictive effect of estimated glomerular filtration rate on clinical prognosis of elderly hospitalized patients

doi:10.16138/j.1673-6087.2025.02.06

Abstract

Abstract:

Objective To investigate the association of several commonly used estimated glomerular filtration rate (eGFR) formula and urinary albumin to creatinine ratio (UACR) with cardiovascular events, renal endpoint events, and mortality in an elderly population.Methods The patients aged ≥ 65 who were treated and had follow-up data more than 1 year in the Department of Geriatrics of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2015 to December 2018 were selected. Logistic regression analyses were used to evaluate the association of eGFR derived by chronic kidney disease epidemiology collaboration(CKD-EPI) creatinine（Cr） formula (CKD-EPI_Cr), CKD-EPI cystatin C formula( CKD-EPI_Cys), the racially neutral CKD-EPI_Cr-Cys formula and Berlin Initiative Study (BIS) formula 2 (based on Cr and cystatin C) with prognosis.Results Totally 475 elderly patients were recruited with a median age of 83(76-87) years and a follow-up time of 76(68-91) months. Before adjustment, those with a decreased eGFR[<60 mL/(min·1.73 m²)] had a higher risk of death when eGFR estimated by CKD-EPI_Cys, CKD-EPI_Cr-Cys, and BIS2, but the association was negative after adjusting by multiple covariates. Before adjustment, those with a decreased eGFR by all equations had a significantly higher risk of cardiovascular events. The odds ratio was highest for eGFR estimated by BIS2. After adjusting for gender, age, and past medical history, the association remains statistically significant between eGFR estimated by BIS2 and cardiovascular events(P=0.038). After adjusting for gender, age, and past medical history, the risk of renal endpoint events was higher in those with decreased eGFR estimated by CKD-EPI_Cr-Cys (P=0.023). None of the other equations showed a significant correlation with renal endpoint events. Before adjustment, those with a decreased eGFR by all equations had a significantly higher risk of composite events. The odds ratio was highest for eGFR estimated by BIS2. After adjusting for gender and age, the association remains statistically significant between composite events and eGFR estimated by CKD-EPI_Cr(P=0.030) fit without race, CKD-EPI_Cys (P=0.044) and BIS2(P=0.034). After multivariate adjustment, those with UACR ≥ 30 mg/g had a significantly higher risk of death, cardiovascular events, renal endpoint events, and composite endpoints compared with those with UACR < 30 mg/g. Elevated UACR was more strongly associated with outcomes than decreased eGFR but not with renal endpoint events.Conclusions Elevated UACR was strongly associated with death, cardiovascular events, and composite endpoints. Among different eGFR formations, decreased eGFR using BIS2 was more strongly associated with cardiovascular events, whereas CKD-EPI_Cr-Cys was more strongly associated with renal endpoint events.

Key words: Elderly people, Estimated glomerular filtration rate, Renal function, Urinary albumin to creatinine, Clinical prognosis

CLC Number:

R692

ZHANG Xiaoyan, XU Jing, QU Bin. Predictive effect of estimated glomerular filtration rate on clinical prognosis of elderly hospitalized patients[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(02): 132-139.

Figures/Tables 3

Table 1

Table 2

Table 3

Univariate and multivariate Logistic regression analyses of eGFR, UACR and endpoint events

公式	死亡			心脑血管事件			肾脏终点事件			复合事件
公式	OR	95%CI	P	OR	95%CI	P	OR	95%CI	P	OR	95%CI	P
CKD-EPI_Cr
未校正	1.57	0.94~2.64	0.087	1.87	1.06~3.28	0.030	2.19	0.97~4.93	0.060	1.90	1.21~2.98	0.005
模型1	1.32	0.76~2.28	0.325	1.68	0.95~2.99	0.076	2.04	0.89~4.66	0.093	1.69	1.05~2.73	0.030
模型2	1.32	0.76~2.31	0.329	1.53	0.85~2.75	0.157	2.03	0.87~4.72	0.101	1.60	0.98~2.60	0.058
模型3	1.12	0.58~2.14	0.740	1.39	0.70~2.79	0.348	1.06	0.39~2.88	0.902	1.34	0.77~2.31	0.301
CKD-EPI_Cys
未校正	1.95	1.18~3.20	0.009	2.36	1.32~4.22	0.004	1.43	0.63~3.26	0.391	2.15	1.41~3.27	<0.001
模型1	1.29	0.75~2.20	0.360	1.92	1.05~3.52	0.036	1.15	0.48~2.72	0.758	1.59	1.01~2.50	0.044
模型2	1.31	0.76~2.27	0.333	1.72	0.93~3.20	0.085	1.19	0.49~2.87	0.699	1.53	0.97~2.43	0.071
模型3	1.13	0.63~2.03	0.677	1.59	0.82~3.09	0.174	0.62	0.23~1.65	0.621	1.29	0.78~2.11	0.319
CKD-EPI_Cr~Cys
未校正	1.73	1.09~2.76	0.020	1.87	1.11~3.13	0.018	3.09	1.38~6.91	0.006	1.84	1.23~2.74	0.003
模型1	1.15	0.69~1.90	0.594	1.50	0.87~2.58	0.145	2.67	1.15~6.19	0.022	1.34	0.87~2.06	0.187
模型2	1.15	0.69~1.92	0.584	1.49	0.81~2.44	0.230	2.8	1.14~6.37	0.023	1.30	0.84~2.02	0.245
模型3	0.91	0.50~1.65	0.911	1.06	0.55~2.04	0.866	1.58	0.60~4.19	0.355	0.95	0.57~1.59	0.836
BIS2
未校正	2.14	1.26~3.64	0.005	3.05	1.59~5.88	0.001	2.08	0.82~5.26	0.122	2.28	1.46~3.54	<0.001
模型1	1.38	0.78~2.46	0.271	2.52	1.27~4.98	0.008	1.75	0.66~4.63	0.260	1.68	1.04~2.70	0.034
模型2	1.41	0.78~2.55	0.254	2.09	1.04~4.21	0.038	1.82	0.67~4.98	0.244	1.57	0.96~2.57	0.070
模型3	1.14	0.61~2.15	0.677	2.00	0.95~4.20	0.067	0.99	0.34~2.94	0.990	1.32	0.78~2.24	0.302
UACR
未校正	2.33	1.40~3.88	0.001	3.94	2.28~6.79	<0.001	2.85	1.28~6.37	0.010	3.61	2.27~5.72	<0.001
模型1	2.01	1.17~3.44	0.011	3.60	2.07~6.27	<0.001	2.55	1.13~5.74	0.024	3.33	2.05~5.41	<0.001
模型2	2.11	1.21~3.67	0.008	3.34	1.88~5.91	<0.001	2.53	1.09~5.85	0.031	3.34	2.03~5.51	<0.001
模型4	1.85	1.05~3.27	0.033	3.28	1.83~5.86	<0.001	2.01	0.85~4.74	0.113	3.15	1.90~5.24	<0.001

Table 3

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公式名称	eGFR计算公式
CKD-EPI_Cr公式（2021）^[3]
SCr≤0.7 mg/dL(女性)	144×(SCr/0.7)^-0.241×0.993 8^年龄
SCr>0.7 mg/dL(女性)	144×(SCr/0.7)^-1.200×0.993 8^年龄
SCr≤0.9 mg/dL(男性)	142×(SCr/0.9)^-0.302×0.993 8^年龄
SCr>0.9 mg/dL(男性)	142×(SCr/0.9)^-1.200×0.993 8^年龄
CKD-EPI_Cys公式（2012）^[4]
SCr≤0.8 mg/dL(女性)	124×(CysC/0.8)^-0.499×0.996 2^年龄
SCr>0.8 mg/dL(女性)	124×(CysC/0.8)^-1.328×0.996 2^年龄
SCr≤0.8 mg/dL(男性)	133×(CysC/0.8)^-0.499×0.996 2^年龄
SCr>0.8 mg/dL(男性)	133×(CysC/0.8)^-1.328×0.996 2^年龄
CKD-EPI_Cr-Cys公式（2021）^[3]
SCr≤0.7 mg/dL,CysC≤0.8 mg/L(女性)	130×(SCr/0.7)^-0.219×(CysC/0.8)^-0.323×0.996 1^年龄
SCr≤0.7 mg/dL,CysC>0.8 mg/L(女性)	130×(SCr/0.7)^-0.219×(CysC/0.8)^-0.778×0.996 1^年龄
SCr>0.7 mg/dL,CysC≤0.8 mg/L(女性)	130×(SCr/0.7)^-0.544×(CysC/0.8)^-0.323×0.996 1^年龄
SCr>0.7 mg/dL,CysC>0.8 mg/L(女性)	130×(SCr/0.7)^-0.544×(CysC/0.8)^-0.778×0.996 1^年龄
SCr≤0.9 mg/dL,CysC≤0.8 mg/L(男性)	135×(SCr/0.9)^-0.144×(CysC/0.8)^-0.323×0.996 1^年龄
SCr≤0.9 mg/dL,CysC>0.8 mg/L(男性)	135×(SCr/0.9)^-0.144×(CysC/0.8)^-0.778×0.996 1^年龄
SCr>0.9 mg/dL,CysC≤0.8 mg/L(男性)	135×(SCr/0.9)^-0.544×(CysC/0.8)^-0.323×0.996 1^年龄
SCr>0.9 mg/dL,CysC>0.8 mg/L(男性)	135×(SCr/0.9)^-0.544×(CysC/0.8)^-0.778×0.996 1^年龄
BIS2公式^[5]
男性	767×CysC^-0.61×SCr^-0.40×年龄^-0.57
女性	767×CysC^-0.61×SCr^-0.40×年龄^-0.57×0.87

项目	检测结果
BMI（kg/m²）	23.9±3.4
收缩压（mmHg）	140.2±19.5
舒张压（mmHg）	73.0±10.4
血红蛋白（g/L）	128.5±16.1
白蛋白（g/L）	37.0（34.0，40.0）
UACR<30 mg/g [n（%）]	377(79.4)
UACR 30~300 mg/g [n（%）]	75(15.8)
UACR≥300 mg/g [n（%）]	23(4.8)
尿素氮（mmol/L）	5.8(4.8，7.1)
血Cr（μmol/L）	81.0(69.0，95.0)
CysC（mg/L）	1.2(1.0，1.4)
尿酸（μmol/L）	331.7±89.0
eGFR[mL/(min·1.73m²）]
CKD-EPI_Cr	76.3（62.1，87.3）
CKD-EPI_Cys	56.7±17.9
CKD-EPI_Cr-Cys	67.3±17.6
BIS2公式	56.3±13.5
甘油三酯（mmol/L）	1.1(0.8，1.5)
胆固醇（mmol/L）	4.3±1.0
低密度脂蛋白（mmol/L）	2.4(1.9，2.9)
空腹血糖（mmol/L）	5.3(4.9，5.9)
糖化血红蛋白（%）	5.8(5.5，6.2)