关于老年慢性肾脏病诊断标准的争议

目前的慢性肾脏病(CKD)诊断标准在很多地方忽视了老年人的特殊性.在评估肾功能方面,由于血清肌酐水平受到肌肉含量、饮食等许多因素的影响,因此,所有基于血清肌酐的肾小球滤过率( GFR)评估公式在实际应用特别是在老年人群中应用时均会出现一定的偏倚.近年来,很多研究证实血清胱抑素C是一项干扰因素较少、相对理想的测定GFR的...

Arguements on diagnostic criteria of chronic kidney disease in elderly

The current diagnostic criteria for chronic kidney disease（CKD） has ignored the particularity of the aged in many aspects.On the assessment of renal function,serum creatinine is affected by many factors,such as the amount of muscle,diet,and so on.Thus all of the creatine-based glomerular filtration rate（GFR） estimations are prone to bias,especially for the elderly.Recently,it has been observed that Cys C may be a more precise endogenous maker of GFR,for it is affected by less factors.On the staging of CKD,one of the major problems is overdiagnosis of old people.It is suggested that stage 1 and 2 should be eliminated and stage 3 needs to be further splited into two parts.However,these considerations remain controversial.Besides,to improve the prognosis evaluation of CKD,it is necessary to combine albuminuria and GFR together to estimate the progression of end-stage renal disease and the risk of all-cause and cardiovascular mortality.