Division of Nephrology, Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Clin J Am Soc Nephrol. 2011 Apr;6(4):724-32. doi: 10.2215/CJN.07700910. Epub 2011 Mar 31.
Increased arterial stiffness was reported to be associated with decreased estimated GFR (eGFR). Previous studies suggested that arterial stiffness might play a role in renal function progression in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether there was an independent association between brachial-ankle pulse wave velocity (baPWV), a marker of arterial stiffness, and renal function progression in CKD patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This longitudinal study enrolled 145 patients with CKD stages 3 to 5. The baPWV was measured by using an ABI-form device. The change in renal function was estimated by eGFR slope. The study endpoints were defined as commencement of dialysis or death.
After a stepwise multivariate analysis, the eGFR slope was positively associated with baseline eGFR and negatively associated with hypertension and baPWV (β=-0.165, P=0.033). Seventeen patients entering dialysis, and eight deaths were recorded. Multivariate forward Cox regression analysis identified that higher baPWV (hazard ratio, 1.001; P=0.001), lower baseline eGFR, and higher serum phosphate level were independently associated with progression to commencement of dialysis or death.
Our results show an independent association between baPWV and renal function decline and progression to commencement of dialysis or death in patients with CKD. Screening CKD patients by means of baPWV may help identify a high-risk group of rapid renal function decline and progression to commencing dialysis or death.
有研究报道，动脉僵硬度的增加与估算肾小球滤过率（eGFR）的降低有关。既往研究表明，动脉僵硬度可能在慢性肾脏病（CKD）患者的肾功能进展中发挥作用。本研究旨在探讨臂踝脉搏波速度（baPWV），一种动脉僵硬度的标志物，与 CKD 患者肾功能进展之间是否存在独立相关性。
设计、设置、参与者和测量：这项纵向研究纳入了 145 名 CKD 3 至 5 期患者。使用 ABI 形式的设备测量 baPWV。通过 eGFR 斜率估计肾功能的变化。研究终点定义为开始透析或死亡。
经过逐步多元分析，eGFR 斜率与基线 eGFR 呈正相关，与高血压和 baPWV 呈负相关（β=-0.165，P=0.033）。有 17 名患者开始透析，8 名患者死亡。多变量向前 Cox 回归分析确定，较高的 baPWV（风险比，1.001；P=0.001）、较低的基线 eGFR 和较高的血清磷酸盐水平与进展至开始透析或死亡独立相关。
我们的研究结果表明，baPWV 与 CKD 患者的肾功能下降和进展至开始透析或死亡之间存在独立相关性。通过 baPWV 对 CKD 患者进行筛查可能有助于识别肾功能迅速下降和进展至开始透析或死亡的高危人群。
