Division of Nephrology, University of Maryland School of Medicine Medical Center, Baltimore, MD 21201, USA.
Clin J Am Soc Nephrol. 2011 Oct;6(10):2403-10. doi: 10.2215/CJN.01670211. Epub 2011 Aug 18.
Brachial artery measures of BP are associated with increasing degrees of proteinuria. Whether central measures of BP or vascular stiffness are associated with increased risk of proteinuria in patients with chronic kidney disease (CKD) is unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Measurements of central and brachial artery BP, and aortic pulse wave velocity (PWV) were performed in a cross-sectional cohort of patients with CKD (n = 2144) from the Chronic Renal Insufficiency Cohort (CRIC) study to determine factors which predict increased risk of proteinuria. Multivariate analysis stratified by diabetes included age, ethnicity, gender, estimated glomerular filtration rate (GFR), waistline, smoking, heart rate, and medications to evaluate the relationship of hemodynamic factors and proteinuria.
Brachial artery systolic BP (SBP) was important as an explanatory factor for variations in proteinuria among both diabetics (R(2) = 0.40, P < 0.0001) and non diabetics (R(2) = 0.38, P < 0.001). Measures of peripheral pulse pressure (PP), central SBP, and central pulse pressure added little to the explained variation in proteinuria beyond brachial artery SBP, whereas PWV as a measure of vascular stiffness incrementally accounted for a significant portion of variation in proteinuria beyond that explained by brachial artery SBP in diabetics (R(2) = 0.42, P < 0.001) but not non diabetics.
Brachial artery SBP and PWV are both associated with variations in proteinuria in patients with CKD.
肱动脉血压（BP）测量值与蛋白尿程度的增加有关。在慢性肾脏病（CKD）患者中，中心血压测量值或血管僵硬程度是否与蛋白尿风险的增加相关尚不清楚。
设计、设置、参与者和测量：在慢性肾脏不全队列（CRIC）研究的 CKD 患者（n=2144）的横断面队列中进行了中心和肱动脉血压以及主动脉脉搏波速度（PWV）的测量，以确定预测蛋白尿风险增加的因素。分层多变量分析包括糖尿病患者的年龄、种族、性别、估计肾小球滤过率（GFR）、腰围、吸烟、心率和药物，以评估血流动力学因素与蛋白尿的关系。
肱动脉收缩压（SBP）是解释糖尿病患者（R(2)=0.40，P<0.0001）和非糖尿病患者（R(2)=0.38，P<0.001）蛋白尿变化的重要因素。外周脉搏压（PP）、中心 SBP 和中心脉压的测量值在肱动脉 SBP 之外对蛋白尿的变化解释很少，而作为血管僵硬度的测量值的 PWV 则在糖尿病患者（R(2)=0.42，P<0.001）但非糖尿病患者中，对肱动脉 SBP 解释的蛋白尿变化之外有显著部分的增量解释。
肱动脉 SBP 和 PWV 均与 CKD 患者的蛋白尿变化有关。
