Association Of Common Geriatric Syndromes With Estimated Glomerular Filtration Rate And Coronary Heart Disease

Background:Sarcopenia is an aging related disease,which can lead to poor prognosis in the elderly,such as energy imbalance,falls,cardiovascular disease and increased mortality.The decrease of energy consumption and increase of visceral fat in patients with sarcopenia play an important role in chronic inflammation.Microinflammatory response is closely related to cardiovascular mortality and total mortality related to renal dysfunction.Renal dysfunction is a common aging disease in the elderly,which is characterized by decreased excretion of metabolic waste and imbalance of electrolyte and acid-base.In China,about 1/3 patients with chronic kidney disease(CKD)have irreversible damage of renal function at the first visit.For patients with end-stage renal disease,the effect of drug treatment is poor,so hemodialysis,peritoneal dialysis,kidney transplantation and other renal replacement methods are often used to maintain part of renal function.However,the cost of renal replacement therapy is high,there are many complications of end-stage renal disease,and most of them have poor prognosis.In recent years,studies have found that sarcopenia is associated with estimated glomerular filtration rate(eGFR)in patients with end-stage renal disease.However,there are few studies on the relationship between sarcopenia and eGFR in people with better renal function.Objective:To investigate the relationship between sarcopenia and eGFR in elderly patients with type 2 diabetes mellitus.Content and methods:188 cases of elderly were selected.The skeletal muscle mass(ASM)was measured by dual energy X-ray,and the muscle mass was calculated by ASM/ht2,ASM/wt and ASM/BMI formula.According to CKD EPIcr-CysC formula,they were divided into two groups:normal eGFR group(n=63 cases,eGFR≥90ml/min·1.73m2)and mild eGFR decrease group(n=125 cases,60≤eGFR<90ml/min·1.73m2).Results:ASM,ASM/ht2,ASM/wt and ASM/BMI in normal eGFR group were significantly higher than those in mild eGFR group(P<0.05).Spearman correlation analysis showed that eGFR was positively correlated with ASM(r=0.231,P<0.001),ASM/ht2(r=0.201,P<0.006),ASM/wt(r=0.313,P<0.000),ASM/BMI(r=0.293,P<0.000)and HDL(r=0.208,P<0.004);It was negatively correlated with age(r=-0.405,P<0.000),body weight(r=-0.240,P<0.001),BMI(r=-0.250,P<0.001),creatinine(r=-0.614,P<0.000),Cystatin C(r=-0.928,P<0.000),uric acid(r=-0.277,P<0.000),diastolic blood pressure(r=-0.254,P<0.000)and abdominal circumference(r=-0.144,P<0.048).Logistic regression analysis showed that eGFR was positively correlated with ASM/wt(OR=0.763,95%CI:0.667~0.874),and negatively correlated with old age(OR=1.331,95%CI:1.190~1.488),hyperuricemia(OR=1.006,95%CI:1.000~1.013)and high diastolic blood pressure(OR=1.089,95%CI:1.041~1.139).Conclusion:The decline of eGFR in elderly patients with type 2 diabetes is mainly associated to elderly,hyperuricemia,high diastolic blood pressure and sarcopenia.Background:Renal dysfunction is one of the common dysfunction in elderly inpatients,including physiological and pathological decline,which can lead to cardiovascular events and death.In the treatment of end-stage renal disease,the effect of drug treatment is poor,the cost of renal replacement medicine is high,and the quality of life of dialysis patients is significantly decreased.In recent years,studies have found that in patients with advanced chronic kidney disease and even end-stage renal disease,the incidence rate of cognitive impairment,anxiety and depression is higher.However,there are few studies on the relationship between estimated glomerular filtration rate(eGFR)and cognitive function in patients with better renal function.Objective:To investigate the relationship between estimated glomerular filtration rate(eGFR)and cognitive function in elderly inpatients with better renal function.Content and methods:According to CKD-EPI formula,633 patients were divided into normal eGFR group(257 cases)(eGFR≥90ml/min·1.73m2)and mild eGFR decrease group(376 cases)(60ml/min·1.73m2≤eGFR<90ml/min·1.73m2).All subjects received laboratory examination and physical examination.Cognitive function was assessed by mini mental state examination(MMSE),Montreal Cognitive Assessment(MoCA),and depression was assessed by Hamilton Depression Scale(HAMD),anxiety was assessed by Hamilton Anxiety Scale(HAMA).Results:The MOCA score,MMSE score,serum albumin,hemoglobin and diastolic blood pressure of the eGFR decreased group were significantly lower than those of the eGFR normal group,while the education level,age,serum homocysteine,serum creatinine,diagnosis number,stroke,hypertension,diabetes and coronary heart disease of the eGFR decreased group were significantly higher than those of the eGFR normal group(P<0.05,table 1),There was no significant difference in HAMD score and HAMA score between the two groups(P>0.05,table 1).Spearman correlation analysis showed that eGFR was positively correlated with MOCA score(r=0.347,P=0.000),MMSE score(r=0.276,P=0.000),serum albumin(r=0.171,P=0.000),diastolic blood pressure(r=0.104,P=0.009)and hemoglobin(r=0.139,P=0.000),serum homocysteine(r=-0.327,P=0.000),serum creatinine(r=-0.684,P=0.000),serum creatinine(r=-0.684,P=0.000)and hemoglobin(r=0.139,P=0.000)Urea(r=-0.269,P=0.000),glycosylated hemoglobin(r=-0.116,P=0.004),age(r=-0.407,P=0.000),number of diagnoses(r=-0.268,P-0.000),history of stroke(r=-0.146,P=0.000),history of hypertension(r=-0.128,P=0.001),history of diabetes(r=-0.161,P=0.000),history of coronary heart disease(r=-0.113,P=0.004)were negatively correlated,eGFR was not correlated with HAMD score and HAMA score(P>0.05)(Table 2).Logistic regression analysis showed that eGFR was positively correlated with high MOCA score(OR=0.951,95%CI:0.919~0.984),age(OR=1.114,95%CI:1.080~1.150),hyperhomocysteinemia(OR=1.067,95%CI:1.037~1.097),more diagnoses(OR=1.063,950%CI:1.013~1.115),and history of stroke(OR=1.628,95%CI:1.037~1.097),95%CI:1.100~2.409)was negatively correlated(P<0.05,table 3).Conclusions:The decline of eGFR in elderly inpatients may be related to old age,stroke history,hyperhomocysteinemia,more diagnosis and cognitive dysfunction.Background:Coronary heart disease is one of the main causes of poor prognosis and high mortality in the elderly.Cognitive function plays an important role in maintaining activities of daily living in elderly patients.Some research indicated that elderly patients with coronary heart disease may have a certain correlation with cognitive impairment.Therefore,we hypothesized that cognitive impairment may be associated with the increased risk of coronary heart disease,thus adding new ideas for the study of risk factors of coronary heart disease.Objective:To explore the association of cognitive impairment and coronary heart disease in elderly inpatients.Content and methods:678 subjects were selected.Their cognitive state was assessed by Montreal Cognitive Assessment(MoCA)Mini Mental State Examination(MMSE),depression was evaluated by Hamilton Depression Scale(HAMD),and anxiety was evaluated by Hamilton Anxiety Scale(HAMA),Barthel index was used to assess the activities of daily living(ADL)and estimated glomerular filtration rate(eGFR)was calculated by CKD-EPI formula.According to the patients’ previous history of myocardial infarction,angina pectoris,coronary angiographic stenosis or coronary revascularization,and confirmed by participant interviews and medical records,the subjects were divided into coronary heart disease group(n=203)and non-coronary heart disease group(n=478).Multivariate logistic regression analysis was used to analyze the risk factors of coronary heart disease.Results:Moca,MMSE and Barthel in CHD group were lower than those in non CHD group,while HAMA and HAMD scores were higher than those in non CHD group,the difference was statistically significant(P<0.05,table 1).Spearman correlation analysis showed that the course of coronary heart disease was related to age(r=0.234,P=0.000),HAMD score(r=0.086,P=0.025),HAMA score(r=0.128,P=0.001),urea(r=0.106,P=0.006),HbAlc(r=0.139,P=0.000),length of hospital stay(r=0.081,P=0.034),course of hypertension(r=0.212,P=0.000),duration of hospital stay(r=0.081,P=0.034)The course of diabetes(r=0.160,P=0.000),hypertension(with/without)(r=0.103,P=0.007),diabetes(with/without)(r=0.131,P=0.001)were positively correlated with MMSE score(r=-0.092,P=0.017),MOCA score(r=-0.157,P=0.000),Barthel score at admission(r=-0.122,P=0.004),Barthel score at discharge(r=-0.114,P=0.000),001),eGFR(r=-0.189,P=0.000),HB(r=-0.114,P=0.003)and body weight(r=-0.086,P=0.025)were negatively correlated(Table 2).Multivariate Logistic regression analysis showed that,the duration of CHD was positively correlated with higher MOCA score(OR=0.962,95%CI:0.931-0.994)(P<0.05),and negatively correlated with older age(OR=1.031,95%CI:1.004-1.058),higher HAMA score(OR=1.042,95%CI:1.014-1.071),longer duration of hypertension(OR=1.024,95%CI:1.010-1.038)and longer duration of diabetes(OR=1.036,95%CI:1.013-1.060)(Table 3).Conclusions:Coronary heart disease in elderly inpatients may be related to old age,long course of hypertension,long course of diabetes,eGFR,anxiety and cognitive function.Early maintenance of cognitive function may have certain significance for the prevention and treatment of coronary heart disease.Background:Frailty increases the risk of falls,disability and death in the elderly.Renal dysfunction is one of the age-related diseases with high incidence in the elderly,and it is one of the main reasons for the repeated treatment of elderly patients.At present,most of the research on the relationship between weakness and renal function is focused on patients with end-stage renal disease.This study aims to study the relationship between the elderly inpatients’ weakness and estimated glomerular filtration rate(eGFR)and unplanned rehospitalization,so as to provide new ideas for the research of elderly patients’weakness and renal dysfunction.Objective:To explore the association between the combined effect of frailty and estimated glomerular filtration rate with non-elective hospital readmission in elderly inpatients.Contents and methods:400 cases of elderly patients were selected.The Fried scale is used to assess frailty,CKD-EPI formula is used to calculate eGFR.The subjects were divided into two groups:non-frailty group(Fried ≦ 2)and frailty group(Fried ≧ 3).The association between frailty and non-elective hospital readmission was analyzed using Cox regression model.The subjects were divided into normal eGFR group(eGFR≧60 ml/min·1.73m2)and mild eGFR decrease group(eGFR<60 ml/min·1.73m2).The relationship between eGFR and non-elective hospital readmission was analyzed by Cox regression model.Finally,according to the Fried score and eGFR,the patients were divided into four groups:group A(no frailty+eGFR normal),group B(no frailty+eGFR decreased),group C(frailty+eGFR normal),and group D(frailty+eGFR decreased).Cox regression analysis was used to analyze the association between the combined effect of asthenia and eGFR and non-elective hospital readmission.Results:A total of 400 subjects were included in this study,including 248 males(62%),118 patients with asthenia(29.5%),and 120 patients with decreased eGFR(30%).There were significant differences in age,creatinine,total protein,albumin,uric acid,total bilirubin,lactate dehydrogenase,alanine aminotransferase,total cholesterol,low density lipoprotein cholesterol and hypertension among different groups(P<0.05).The results of follow-up survival analysis showed that there were 97 cases of non-selective readmission within 6 months after discharge.The incidence of group A was 21%(45/212),group B was 26%(18/70),group C was 24%(16/68),and group D was 36%(18/50).Kaplan Meier curve also showed the same trend(overall χ2=11.213,P=0.011).The event free survival rates of group A(χ2=10.398,P=,0001)and group C(χ2=5.876,P=0.015)were higher than those of group D,while there was no significant difference between group B(χ2=2.208,P=0.137)and Group D.Cox regression was used to analyze the association of frailty and decreased eGFR with readmission within 6 months.The results suggest that after adjusting for confounding factors,the decline of eGFR is associated with readmission within 6 months,while frailty is not associated with readmission.The risk of rehospitalization within 6 months in patients with decreased eGFR was 1.777 times higher than that in patients with normal eGFR(95%CI:1.001～3.154),while the risk of rehospitalization within 6 months in frailty patients and non-frailty patients had no significant difference.Multivariate Cox regression analysis showed that after adjusting for age,gender,smoking,uric acid,triglyceride,high density lipoprotein,diabetes and coronary heart disease,the risk of readmission in group D was 2.295 times higher than that in group A(95%CI:1.096-4.810),with statistical significance.The risk of rehospitalization in group B was 1.401 times of that in group A(95%CI:0.665-2.953),while that in group C was 91.8%(95%CI:0.403-2.092),but the difference was not statistically significant.Conclusions:The decline of eGFR is associated with non-elective hospital readmission in elderly inpatients within 6 months,while frailty is not associated with rehospitalization.The combined effect of asthenia and eGFR in elderly inpatients is related to non-elective hospital readmission.