Vlek Anne L M, van der Graaf Yolanda, Braam Branko, Moll Frans L, Nathoe Hendrik M, Visseren Frank L J
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Am J Kidney Dis. 2009 Nov;54(5):820-9. doi: 10.1053/j.ajkd.2009.07.007. Epub 2009 Sep 6.
Increased blood pressure generally is associated with kidney function decrease. We evaluated the rate of kidney function decrease, the effect of blood pressure on kidney function deterioration, and the possible interaction with albuminuria in patients with vascular disease.
Prospective cohort study.
SETTING & PARTICIPANTS: 745 patients with vascular disease from the Second Manifestations of Arterial Disease (SMART) Study.
Blood pressure, hypertension presence, albuminuria (albumin-creatinine ratio > 27 mg/g).
Rate of kidney function decrease, calculated from the difference between 2 estimated glomerular filtration rate (eGFR) values divided by the individual follow-up time.
Participants underwent vascular screening at baseline and after a mean follow-up of 4.5 +/- 1.0 years. Rate of kidney function decrease was expressed as annual decrease in eGFR. Linear regression analysis was used to evaluate the relation between blood pressure and eGFR decrease.
Mean baseline eGFR was 79.3 +/- 16.3 mL/min/1.73 m(2), and mean annual decrease in eGFR was 1.00 +/- 2.71 mL/min/1.73 m(2). In 35% of patients, eGFR was stable during follow-up. Albuminuria was present in 100 patients (median albumin-creatinine ratio, 58 mg/g). In patients without albuminuria, age-, sex-, and baseline eGFR-adjusted annual eGFR decrease was 0.86 mL/min/1.73 m(2), whereas this was 1.89 mL/min/1.73 m(2) in patients with albuminuria (P < 0.05). In the presence of albuminuria, higher blood pressure was associated with greater eGFR decrease (beta = 1.29; 95% CI, 0.73-1.85 for systolic blood pressure and beta = 3.86; 95% CI, 2.34-5.38 for hypertension presence). In patients without albuminuria, no association was found between blood pressure and kidney function decrease (beta = 0.15; 95% CI, -0.05 to 0.36 for systolic blood pressure and beta = 0.12; 95% CI, -0.28 to 0.52 for hypertension presence; P for interaction term < 0.05).
Participants might reflect a healthier subgroup of patients with vascular disease. Creatinine was measured only twice.
Kidney function decrease in patients with vascular disease is considerable. Blood pressure is a strong risk factor for eGFR decrease in patients with vascular disease and albuminuria.
血压升高通常与肾功能下降有关。我们评估了血管疾病患者的肾功能下降速率、血压对肾功能恶化的影响以及与蛋白尿的可能相互作用。
前瞻性队列研究。
来自动脉疾病二次表现（SMART）研究的745例血管疾病患者。
血压、高血压、蛋白尿（白蛋白-肌酐比值>27mg/g）。
肾功能下降速率，通过两个估算肾小球滤过率（eGFR）值之差除以个体随访时间计算得出。
参与者在基线时和平均随访4.5±1.0年后接受血管筛查。肾功能下降速率以eGFR的年下降值表示。采用线性回归分析评估血压与eGFR下降之间的关系。
平均基线eGFR为79.3±16.3ml/min/1.73m²，eGFR的平均年下降值为1.00±2.71ml/min/1.73m²。35%的患者在随访期间eGFR稳定。100例患者存在蛋白尿（白蛋白-肌酐比值中位数为58mg/g）。在无蛋白尿的患者中，经年龄、性别和基线eGFR调整后的eGFR年下降值为0.86ml/min/1.73m²，而在有蛋白尿的患者中为1.89ml/min/1.73m²（P<0.05）。在存在蛋白尿的情况下，血压升高与更大的eGFR下降相关（收缩压的β=1.29；95%CI，0.73-1.85；高血压的β=3.86；95%CI，2.34-5.38）。在无蛋白尿的患者中，未发现血压与肾功能下降之间存在关联（收缩压的β=0.15；95%CI，-0.05至0.36；高血压的β=0.12；95%CI，-0.28至0.52；交互项P<0.05）。
参与者可能代表血管疾病患者中更健康的亚组。肌酐仅测量了两次。
血管疾病患者的肾功能下降相当明显。血压是血管疾病和蛋白尿患者eGFR下降的一个重要危险因素。
