Thilly Nathalie, Boini Stéphanie, Kessler Michèle, Briançon Serge, Frimat Luc
Department of Clinical Epidemiology and Evaluation, CEC-CIE6 Inserm, EA 4003, Nancy University, Nancy, France.
Nephrol Dial Transplant. 2009 Mar;24(3):934-9. doi: 10.1093/ndt/gfn566. Epub 2008 Nov 11.
Little is known about antihypertensive management and control of blood pressure (BP) and proteinuria in patients with chronic kidney disease (CKD). Data from a large observational study (AVENIR), carried out in Lorraine (France), were used to analyse antihypertensive treatment and control of BP and proteinuria in patients with advanced CKD, under nephrologist care or not.
All adults with CKD, beginning dialysis in 2005 and 2006, were included and categorized into patients 'under nephrologist care' and 'not under nephrologist care' at the time when treatment, BP and proteinuria results were considered. All data were collected retrospectively from medical records. Demographic and clinical data were from initiation of dialysis. BP, biological and therapeutic data were results obtained at 2.7 months before dialysis for patients under nephrologist care, and results obtained at the first nephrology consultation for those not under such care (2.7 +/- 3.7 months before dialysis).
On 566 included patients, the 291 under nephrologist care received more antihypertensive agents (3.1 +/- 1.5 versus 2.2 +/- 1.6) than the 275 not under such care and each antihypertensive class was more often prescribed for these patients, particularly the renin-angiotensin-aldosteron system inhibitors (60.5% versus 36.7%). Nevertheless, BP did not differ between both groups, and proteinuria control was achieved in more patients not under nephrologist care, revealing a likely bias of indication. Whatever the type of care, BP < 130/80 mmHg was achieved in only one quarter of all patients and proteinuria < 0.5 g/day in only 15% of them.
Understanding the reasons for such a poor level of hypertension and proteinuria control in CKD patients needs to be explored in further investigations.
对于慢性肾脏病（CKD）患者的降压管理以及血压（BP）和蛋白尿的控制情况，人们了解甚少。来自法国洛林地区一项大型观察性研究（AVENIR）的数据，被用于分析晚期CKD患者在接受或未接受肾病专家治疗情况下的降压治疗以及血压和蛋白尿的控制情况。
纳入所有在2005年和2006年开始透析的成年CKD患者，并在考虑治疗、血压和蛋白尿结果时，将其分为“接受肾病专家治疗”和“未接受肾病专家治疗”两组。所有数据均从医疗记录中回顾性收集。人口统计学和临床数据来自透析开始时。对于接受肾病专家治疗的患者，血压、生物学和治疗数据是透析前2.7个月时获得的结果；对于未接受此类治疗的患者，是在首次肾病会诊时获得的结果（透析前2.7±3.7个月）。
在纳入的566例患者中，接受肾病专家治疗的291例患者比未接受此类治疗的275例患者使用了更多的降压药物（3.1±1.5种 vs 2.2±1.6种），并且每种降压药物类别在这些患者中更常被处方，尤其是肾素 - 血管紧张素 - 醛固酮系统抑制剂（60.5% vs 36.7%）。然而，两组之间的血压并无差异，并且在未接受肾病专家治疗的患者中，更多患者实现了蛋白尿控制，这显示出可能存在指征偏倚。无论治疗类型如何，所有患者中仅有四分之一的患者血压<130/80 mmHg，仅有15%的患者蛋白尿<0.5 g/天。
需要在进一步的研究中探究CKD患者高血压和蛋白尿控制水平如此之低的原因。
