慢性腎臟病已被公認為是全球主要的公共衛生議題，也是台灣健保支出最多的疾病。早期慢性腎臟病常常不易被發現，當出現明顯症狀時通常已到末期，因此透過早期診斷，早期治療，進而防止惡化為末期腎臟病更顯重要。本研究採用橫斷面分析研究設計，使用「台北市老人健檢資料庫」以及美國國家健康與營養檢查調查（NHANES）中提取的老年人（65歲及65歲以上）的數據資料，選取相關變項共分成三個部分進行分析，分別為(1)首先評估生活方式因素（運動習慣、飲酒、吸煙史和嚼檳榔）可能影響65歲與65歲以上老人腎功能下降之間的關聯。(2) 比較台灣台北市老人有或沒有血脂異常和/或心血管疾病（CVD）與老年人慢性腎臟病（CKD）的危險因素。(3) 再運用美國國家健康與營養檢查調查（NHANES）中提取美國老年人（65歲及65歲以上）資料庫，橫斷面研究評估生活方式因素與eGFR是否降低之間的關聯性。
    主要研究發現: (1) 在65歲以上的社區老年人中，有經常性運動的良好生活習慣老人與 eGFR 延緩下降有關聯，吸煙與 eGFR 降低的風險升高有顯著關聯，此外，運動習慣對降低 eGFR 的保護作用不受高血壓、糖尿病、肥胖和心血管疾病等合併症的影響。(2) 性別、年齡、收入、血脂、尿蛋白和有高尿酸血症、痛風病史是為患有或不患有高脂血症的老年人發展CKD 有效篩選與預防策略的潛在影響因子，而吸煙、飲酒和咀嚼檳榔則不受影響。高尿酸或 BUN 數值也可考慮用於老年高脂血症和 CVD 患者的 CKD 篩檢策略中。 (3)在美國65 歲及以上老年人中，尿蛋白、心血管疾病、糖尿病、高尿酸血症和高血壓與腎功能降低的機率顯著相關，充足的運動與腎功能降低機率有顯著關聯。

Chronic kidney disease (CKD) is known as an issue in public health since patients have an increased risk of end-stage renal disease (ESRD). CKD is diagnosed by the presence of abnormalities in estimated glomerular filtration rate (eGFR) and markers of kidney damage that include albuminuria and hematuria for more than 3 months. 
This study would provide three cross-sectional population-based study to understand the risk factors for CKD in elder adults. (1) we aimed to evaluate the associations between lifestyle factors (alcohol consumption, exercise frequency, smoking history, and betel nut chewing) of elder people over 65 years old by Taipei City Elderly Health Examination database. (2) The associations between conventional CKD risk factors and CKD were comparable between participants with and without hyperlipidemia of elder people over 65 years old by Taipei City Elderly Health Examination database. (3) The associations between lifestyle factors and eGFR levels in older adults over 65 years old by analyzing the United States National Health and Nutrition Examination Survey (NHANES) data.
The major finding of this study: (1) The habit of physical exercise was beneficially associated with reduced eGFR in older individuals. However smoking habit was harmful to kidney function. Otherwise, exercise habit would protect eGFR for the effects of hypertension, diabetes, overweight and cardiovascular disease (CVD) by cross-section analysis. (2) Gender, age, income, hyperlipemia, proteinuria and hyperuricemia were the potential risk factors of CKD. Uric acid and blood urea nitrogen (BUN) could be considered in cardiovascular and CKD a screening strategy in older individual. (3) Proteinuria, CVD, diabetes, hyperuricemia and hypertension were significantly associated with decreasing of renal function in a ten-year analysis of a US eligible database.

Contents	V
List of Figures	VII
List of Tables	VIII
Chapter1 Introduction	1
1.1 Background	1
1.2 Research Purpose	2
1.3 Research Question	4
Chapter2 Literature review	6
2.1 Preventive Health Examination	6
2.2 Chronic kidney disease (CKD)	7
2.3 Cardiovascular disease, CVD	13
2.4 The risk factors of CKD	15
Chapter 3 Methodology	16
3.1 Research concept	16
3.2 Case study 1:Taipei City Elderly Health Examination Database 2006-2013	16
3.3 Case study 2: Taipei City Elderly Health Examination Database 2010 -2011	19
3.4 Case study 3: NHANES 1999-2000,2015-2016	22
Chapter 4 Results	27
4.1 Case study 1:Taipei City Elderly Health Examination Database 2006-2013	27
4.2 Case study 2: Taipei City Elderly Health Examination Database 2010 -2011	35
4.3 Case study 3: NHANES 1999-2000,2015-2016	44
Chapter 5 Discussion	52
5.1 Case study 1:Taipei City Elderly Health Examination Database 2006-2013	52
5.2 Case study 2: Taipei City Elderly Health Examination Database 2010 -2011	55
5.3 Case study 3: Taipei City Elderly Health Examination Database 2010 -2011	58
Chapter 6 Conclusion and suggestion	63
6.1 Conclusion	63
6.2 Implication	65
6.3 Study limitation	70
6.4 Future and further research	71
References	73

List of Figures
Figure 3.1 Research Concept Diagram	16
Figure 4.2 The flowchart of study population	27
Figure 4.3 Flowchart of study population	38
Figure 4.4 Analytic target population	46
Figure 4.5 Distribution of alcohol drinks per week in participants with eGFR	46
 
List of Tables
Table 2.1. The program of health examination in Taipei City.	7
Table 2.2. Stage of chronic kidney disease.	13
Table 2.3. Risk factors of CKD.	15
Table 4.4. Factors of the target population of database.	29
Table 4.5. Factors of participants with decreased or normal eGFR.	31
Table 4.6. Associations between study variables and eGFR<60 in the total study population.	33
Table 4.7. Effects of gender and comorbidity on the association between exercise habit and decreased kidney function, determined by stratified analyses.	35
Table 4.8. Target population of the cross-section analysis study.	37
Table 4.9. Characteristics of subjects with low and high eGFR, stratified by dyslipidemia and cardiovascular disease status.	40
Table 4.10. Effect of risk factors on reduced eGFR by univariate logistic regression models.	42
Table 4.11. Effect of risk factors on reduced eGFR by multivariate logistic regression models.	43
Table 4.12. Demographic, lifestyle-related, and clinical characteristics of the study population stratified by eGFR levels.	48
Table 4.13. Significant interaction terms between covariates.	49
Table 4.14. Associations between risk factors and reduced kidney function (eGFR < 60 ml/min/1.73m2) evaluated by logistic regression analysis.	50
Table 4.15. Associations between risk factors and reduced kidney function (eGFR < 60 ml/min/1.73m2) by gender.	51

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