ltiple ways to measure differences in creatinine and cystatin C; all produce similar associations with aging-related adverse outcomes. Background eGFR calculated using creatinine and cystatin C often differ in older adults. We hypothesized that older adults with cystatin C–based eGFR (eGFRcys) values significantly lower than creatinine-based eGFR (eGFRcr) values may have higher risk of aging-related adverse outcomes, independent of kidney function. Methods We conducted a longitudinal cohort study of adults 65 years and older from the Health and Retirement Study, a cohort of older American adults, to determine the relationship between eGFR discordance and aging-related adverse outcomes. We calculated eGFRcr and eGFRcys using baseline creatinine and cystatin C measurements. A large eGFR discordance was defined as eGFRcys >30% lower than eGFRcr. We assessed four aging-related adverse outcomes over a 2-year follow-up: falls, hip fractures, hospitalizations, and death. We fit separate multivariable regression models to determine the association between having a large eGFR discordance and each outcome adjusting for confounders, including kidney function. Results Of 5574 older adults, 1683 (30%) had a large eGFR discordance. Those with a large eGFR discordance were more likely to be older, female, and White. The prevalence of a large eGFR discordance increased with age, from 20% among those 65–69 years to 44% among those 80 years and older. Over a 2-year follow-up, there were 305 deaths (5.5%), 2013 falls (39.2%), 69 hip fractures (1.3%), and 1649 hospitalizations (32.2%). In adjusted analyses, large eGFR discordance was associated with a higher hazard ratio for death (hazard ratio, 1.43; 95% confidence interval [CI], 1.12 to 1.82) and significantly higher odds of falls (odds ratio, 1.32; 95% CI, 1.16 to 1.51) and hospitalizations (odds ratio, 1.32; 95% CI, 1.15 to 1.51). A large eGFR discordance was not associated with hip fractures. Conclusions In a large, nationally representative cohort of older adults, prevalence of eGFR discordance increased with age and was associated with higher risk of falls, hospitalization, and death, independent of kidney function....

中文翻译：

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基于肌酐和基于胱抑素 C 的 eGFR 之间的巨大不一致与老年人的跌倒、住院和死亡有关


l测量肌酐和胱抑素 C 差异的方法;都与衰老相关的不良结局产生类似的关联。背景使用肌酐和胱抑素 C 计算的 eGFR 在老年人中通常不同。我们假设基于胱抑素 C 的 eGFR （eGFRcys） 值显著低于基于肌酐的 eGFR （eGFRcr） 值的老年人可能具有更高的衰老相关不良结局风险，这与肾功能无关。方法 我们对来自美国老年人队列 Health and Retirement Study 的 65 岁及以上的成年人进行了纵向队列研究，以确定 eGFR 不一致与衰老相关不良结果之间的关系。我们使用基线肌酐和胱抑素 C 测量值计算 eGFRcr 和 eGFRcys。较大的 eGFR 不一致被定义为 eGFRcys >30% 低于 eGFRcr。我们在 2 年的随访中评估了 4 种与衰老相关的不良结局： 跌倒、髋部骨折、住院和死亡。我们拟合单独的多变量回归模型，以确定 eGFR 不一致较大的结果与调整混杂因素（包括肾功能）的每个结果之间的关联。结果 在 5574 名老年人中，1683 名 （30%） 存在较大的 eGFR 不一致。eGFR 不一致较大的人更可能是老年人、女性和白人。较大的 eGFR 不一致的患病率随着年龄的增长而增加，从 65-69 岁的 20% 增加到 80 岁及以上的 44%。在 2 年的随访中，有 305 例死亡 （5.5%），2013 例跌倒 （39.2%），69 例髋部骨折 （1.3%） 和 1649 例住院 （32.2%）。在调整后的分析中，较大的 eGFR 不一致与较高的死亡风险比相关（风险比，1.43;95% 置信区间 [CI]，1.12 比 1。82） 和显著更高的跌倒几率 （比值比，1.32;95% CI，1.16 至 1.51） 和住院 （比值比，1.32;95% CI，1.15 至 1.51）。较大的 eGFR 不一致与髋部骨折无关。结论 在一个大型的、具有全国代表性的老年人队列中，eGFR 不一致的患病率随着年龄的增长而增加，并且与跌倒、住院和死亡的风险增加有关，与肾功能无关。