夜间低氧血症与 CKD 进展的关系。
Association of nocturnal hypoxemia with progression of CKD.
机构信息
Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Japan.
出版信息
Clin J Am Soc Nephrol. 2013 Sep;8(9):1502-7. doi: 10.2215/CJN.11931112. Epub 2013 Jun 6.
BACKGROUND AND OBJECTIVES
Nocturnal hypoxemia is highly prevalent among patients with CKD. Nocturnal hypoxemia contributes to systemic inflammation, oxidative stress, endothelial cell dysfunction, and activation of the renin-angiotensin system, which are common pathologic mechanisms of CKD progression. This study investigated whether nocturnal hypoxemia is independently associated with CKD progression.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This two-center retrospective cohort study included 161 patients with stages 3-4 CKD enrolled from January of 2009 to July of 2011 with a body mass index less than 25.0 kg/m(2). The 4% oxygen desaturation index, the number of events per hour in which oxygen saturation decreases by >4% during sleep, was measured, and the declining rate of the estimated GFR was followed over 1 year. The severity of nocturnal hypoxemia was categorized as none (oxygen desaturation index<5.0), mild (5.0≤oxygen desaturation index<15.0), or moderate to severe (15.0≤oxygen desaturation index).
RESULTS
The mean estimated GFR of the total cohort at baseline was 31 ml/min per 1.73 m(2). Eighty patients (49.7%) were diagnosed with nocturnal hypoxemia; 64 patients were diagnosed with mild nocturnal hypoxemia, and 16 patients were diagnosed with moderate-to-severe nocturnal hypoxemia. The estimated GFR declined three- to fourfold faster in patients with moderate-to-severe nocturnal hypoxemia than patients with no or mild nocturnal hypoxemia (the mean values [95% confidence intervals] were -2.14 [-1.06 to -3.21], -3.02 [-1.31 to -4.74], and -8.59 [-2.00 to -15.2] ml/min per 1.73 m(2) per year in the no, mild, and moderate-to-severe nocturnal hypoxemia groups, respectively; P=0.003). Nocturnal hypoxemia remained a significant predictor of decline in estimated GFR after adjustment for various baseline clinical factors.
CONCLUSIONS
In nonobese patients with CKD, nocturnal hypoxemia is an independent risk factor of a rapid decline in kidney function.
背景与目的
夜间低氧血症在 CKD 患者中非常普遍。夜间低氧血症会导致全身炎症、氧化应激、内皮细胞功能障碍和肾素-血管紧张素系统激活，这些都是 CKD 进展的常见病理机制。本研究旨在探讨夜间低氧血症是否与 CKD 进展有关。
设计、地点、参与者和测量：本项两中心回顾性队列研究纳入了 2009 年 1 月至 2011 年 7 月期间BMI 小于 25.0kg/m2的 161 例 3-4 期 CKD 患者。测量 4%氧减饱和指数（睡眠中氧饱和度下降超过 4%的事件数/小时），并在 1 年内随访估计肾小球滤过率（eGFR）的下降率。夜间低氧血症的严重程度分为无（氧减饱和指数<5.0）、轻度（5.0≤氧减饱和指数<15.0）或中重度（15.0≤氧减饱和指数）。
结果
总队列的基线 eGFR 平均值为 31ml/min/1.73m2。80 例（49.7%）患者被诊断为夜间低氧血症；64 例为轻度夜间低氧血症，16 例为中重度夜间低氧血症。中重度夜间低氧血症患者的 eGFR 下降速度是无或轻度夜间低氧血症患者的 3-4 倍（平均（95%置信区间）分别为-2.14[-1.06 至-3.21]、-3.02[-1.31 至-4.74]和-8.59[-2.00 至-15.2]ml/min/1.73m2/年；P=0.003）。调整各种基线临床因素后，夜间低氧血症仍是 eGFR 下降的独立预测因素。
结论
在非肥胖的 CKD 患者中，夜间低氧血症是肾功能快速下降的独立危险因素。
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