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适应年龄和独立年龄的eGFR值来诊断CKD:整合辩论并绘制一个平衡的前进路径
Pierre Delanaye1,2,3, Priya Vart4, Jürgen Floege5
1Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium.
Clinical kidney journal
|November 17, 2025
概括
诊断慢性病 (CKD) 的最佳方法包括平衡适应年龄和独立于年龄的估计球过率 (eGFR) 截止值. 以患者为中心,基于风险的策略对于准确的CKD诊断和护理至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 老年病的医生 老年病的医生
- 临床流行病学 临床流行病学
背景情况:
- 慢性病 (CKD) 的诊断依赖于估计的膜过率 (eGFR) 值,但关于适应年龄和不依赖年龄的切断值存在争论.
- 生理衰老与GFR的自然下降有关,导致老年人使用固定值对CKD的潜在过度诊断.
研究的目的:
- 探索使用适应年龄和不依赖年龄的EGFR切断值来诊断CKD之间的紧张关系.
- 评估不同年龄组的临床影响和支持每个方法的证据.
主要方法:
- 对与年龄相关的GFR下降的生理学研究的综述.
- 对eGFR,心血管事件和死亡率的大规模流行病学数据的分析.
- 讨论诊断标准中的临床实用主义与生理学准确性.
主要成果:
- 适应年龄的切断值可以防止健康的老年人过度诊断,但在年轻人中风险低诊断.
- 独立于年龄的切断线确定了老年人与EGFR 45-59毫升/分钟/1.73米2的风险增加,但可能错误地分类健康个体.
- 有证据表明,具有降低EGFR的老年人面临着严重的不良结果风险.
结论:
- 无论是适应年龄的还是独立于年龄的截止值都不是普遍最佳的.
- 建议采用平衡,以患者为中心和基于风险的方法,可能包括个性化风险预测,用于CKD诊断和管理.
- 共享决策可以提高CKD诊断在整个生命周期的临床意义.
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