Nakagawa Naoki, Takahashi Fumihiko, Chinda Junko, Kobayashi Motoi, Hayashi Yoshikazu, Abe Masahiko, Saijo Yasuaki, Kikuchi Kenjiro, Hasebe Naoyuki
Cardiovascular Division, Department of Internal Medicine, Asahikawa Medical College, Asahikawa, Japan.
Hypertens Res. 2008 Feb;31(2):193-201. doi: 10.1291/hypres.31.193.
Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease, and thus is a major worldwide public health problem. Recently, an estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation for Japanese patients was proposed by the Japanese Society of Nephrology. However, the role of eGFR in the assessment of atherosclerosis is not well understood in Japanese patients. We analyzed the relationship between eGFR and severity of arterial stiffness using brachial-ankle pulse wave velocity (baPWV) in 647 adult Japanese patients. baPWV correlated significantly and positively with age, hypertension, diabetes, prior cardiovascular disease, blood pressure, pulse pressure and heart rate, and negatively with eGFR (r=-0.405, p<0.0001). A multiple regression analysis revealed that baPWV correlated independently with eGFR. Furthermore, there was a stepwise increase in baPWV, corresponding to advances in CKD through stages 1 to 5. When CKD stage 3 was divided at eGFR 45 mL/min/1.73 m2, the baPWV of stage 3b (eGFR 30 to 44) was significantly higher than that of stage 3a (eGFR 45 to 59) independent of traditional risk factors, suggesting that an eGFR of 45 mL/min/1.73 m2 may be a critical cut off value to predict arterial stiffness in CKD. In conclusion, the newly proposed eGFR is significantly associated with arterial stiffness, independent of traditional risk factors for cardiovascular disease.
慢性肾脏病(CKD)与心血管疾病风险增加相关,因此是一个全球性的重大公共卫生问题。最近,日本肾脏病学会提出了使用肾脏病饮食改良公式来估算日本患者的肾小球滤过率(eGFR)。然而,在日本患者中,eGFR在动脉粥样硬化评估中的作用尚未得到充分了解。我们分析了647名成年日本患者的eGFR与使用臂踝脉搏波速度(baPWV)评估的动脉僵硬度严重程度之间的关系。baPWV与年龄、高血压、糖尿病、既往心血管疾病、血压、脉压和心率呈显著正相关,与eGFR呈负相关(r = -0.405,p < 0.0001)。多元回归分析显示,baPWV与eGFR独立相关。此外,随着CKD从1期进展到第5期,baPWV呈逐步升高。当CKD 3期以eGFR 45 mL/min/1.73 m²为界划分时,3b期(eGFR 30至44)的baPWV显著高于3a期(eGFR 45至59),且不受传统危险因素影响,这表明eGFR 45 mL/min/1.73 m²可能是预测CKD患者动脉僵硬度的关键临界值。总之,新提出的eGFR与动脉僵硬度显著相关,且独立于心血管疾病的传统危险因素。