Renal and Transplantation Unit, St. George's Hospital NHS Trust, Tooting, London - UK.
J Nephrol. 2010 Mar-Apr;23(2):189-93.
Pulse pressure (PP) is a predictor of adverse outcomes in patients on haemodialysis and with predialysis chronic kidney disease (CKD). However, the relationship between PP and kidney disease progression is not clear in mild to moderate CKD, which this study aimed to investigate.
CKD patients (n=329) were followed up for 172 +/- 93 days (mean +/- SD). The clinical characteristics at baseline were, age 64 +/- 17 years, 62% males, 27% diabetics, estimated glomerular filtration rate (eGFR) 39 +/- 18 ml/min per 1.73 m2, systolic blood pressure (SBP) 141 +/- 24 mm Hg, diastolic blood pressure (DBP) 76 +/- 12 mm Hg and PP 65 +/- 20 mm Hg. On follow-up, eGFR decreased (39 +/- 18 vs. 38+/-18 ml/min per 1.73 m2; p<0.01), SBP and PP improved (141 +/- 24 mm Hg vs. 133 +/- 19 mm Hg; p<0.001; and 65 +/- 20 mm Hg vs. 59+/-17 mm Hg; p<0.001), and DBP was unchanged.
Declining kidney function as assessed by eGFR was inversely related to baseline SBP (r=-0.15; p<0.01) and PP (r=-0.18; p<0.001), but no relationship with DBP was observed. During follow-up, baseline PP correlated with declining eGFR (r=-0.15; p<0.01) similar to SBP (r=-0.15; p<0.01), but DBP did not. Patients with declining eGFR had higher PP (69 +/- 20 mm Hg vs. 62 +/- 20 mm Hg; p<0.005), higher SBP (145 +/- 23 mm Hg vs. 138 +/- 25 mm Hg; p<0.05) but similar DBP (76 +/- 12 mm Hg vs. 76 +/- 12 mm Hg; p=0.8) compared with patients with stable eGFR.
Baseline PP was the only predictor of eGFR decline adjusted for age, baseline eGFR, diabetes, haemoglobin and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. PP >65 mm Hg was associated declining renal function (log rank chi-square; p<0.05). This study suggests that PP is a better predictor of adverse renal outcome even in mild to moderate CKD, than DBP or even SBP.
脉压（PP）是血液透析患者和透析前慢性肾脏病（CKD）患者不良预后的预测指标。然而，在轻度至中度 CKD 中，PP 与肾脏疾病进展之间的关系尚不清楚，本研究旨在对此进行探讨。
对 329 例 CKD 患者进行了 172 +/- 93 天（平均值 +/- 标准差）的随访。基线时的临床特征为：年龄 64 +/- 17 岁，62%为男性，27%为糖尿病患者，估算肾小球滤过率（eGFR）为 39 +/- 18 ml/min per 1.73 m2，收缩压（SBP）为 141 +/- 24 mm Hg，舒张压（DBP）为 76 +/- 12 mm Hg，PP 为 65 +/- 20 mm Hg。随访期间，eGFR 下降（39 +/- 18 与 38 +/- 18 ml/min per 1.73 m2；p<0.01），SBP 和 PP 改善（141 +/- 24 与 133 +/- 19 mm Hg；p<0.001；65 +/- 20 与 59 +/- 17 mm Hg；p<0.001），DBP 不变。
eGFR 下降与基线 SBP（r=-0.15；p<0.01）和 PP（r=-0.18；p<0.001）呈负相关，但与 DBP 无相关性。在随访期间，基线 PP 与 eGFR 的下降相关（r=-0.15；p<0.01），与 SBP 相似（r=-0.15；p<0.01），但与 DBP 无关。与 eGFR 稳定的患者相比，eGFR 下降的患者 PP 更高（69 +/- 20 mm Hg 与 62 +/- 20 mm Hg；p<0.005），SBP 更高（145 +/- 23 mm Hg 与 138 +/- 25 mm Hg；p<0.05），但 DBP 相似（76 +/- 12 mm Hg 与 76 +/- 12 mm Hg；p=0.8）。
在调整年龄、基线 eGFR、糖尿病、血红蛋白和使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂后，基线 PP 是 eGFR 下降的唯一预测因素。PP >65 mm Hg 与肾功能下降相关（对数秩卡方检验；p<0.05）。本研究表明，PP 是预测轻度至中度 CKD 不良肾脏结局的更好指标，优于 DBP 甚至 SBP。
