Suzuki Hiromichi, Inoue Tsutomu, Dogi Mami, Kikuta Tomohiro, Takenaka Tsuneo, Okada Hirokazu
Department of Nephrology, Saitama Medical University, Saitama, Japan.
Omron Health Care Co. Ltd., Kyoto, Japan.
Pulse (Basel). 2014 May;2(1-4):29-37. doi: 10.1159/000368678. Epub 2014 Oct 31.
Invasive and noninvasive methods for evaluating the effects of hemodynamics on progression of left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD) have been proposed. Central aortic pressure (CAP) has been reported to be the best among selected measures of hemodynamics for predicting LVH. However, there are few studies examining the relation between longitudinal changes in CAP and renal dysfunction in patients with CKD.
Sixty-seven patients with CKD stages 3-5 (female/male ratio: 26/41, age: 61.5 ± 13.1 years) were followed for 5 years. Before and at the end of the 5-year period, CAP was recorded by an automated tonometric system (HEM-9000 AI; Omron Healthcare, Kyoto, Japan). Second systolic aortic blood pressure (SBP2) was employed as an index of CAP.
Throughout the study, systolic blood pressure (SBP) was well controlled. Renal function followed by estimated glomerular filtration rate (eGFR) gradually worsened as a whole. Ten patients had renal replacement therapy, 3 patients developed cardiovascular diseases and 2 patients were found to have a neoplasm during the 5-year observation period. SBP2 increased from 120 ± 19 to 125 ± 33 mm Hg and eGFR decreased from 38.2 ± 18.2 to 29.5 ± 16.3 ml/min/1.73 m(2); however, these differences did not achieve significance. The left ventricular mass (LVM) index significantly increased from 115.5 ± 10.5 to 131.2 ± 11.7 g/m(2) (p < 0.05). Although the changes in SBP2 and eGFR looked like a mirror image, there was no significant correlation between the two factors. Moreover, multivariate regression analysis did not reveal a close correlation between SBP2 and CKD progression. In contrast to the decline of renal function, the baseline value of SBP2 predicted an increase in the LVM index.
Worsening of renal dysfunction is not solely dependent on hemodynamics. Other factors might be involved in a complex manner.
已提出评估血流动力学对慢性肾脏病（CKD）患者左心室肥厚（LVH）进展影响的侵入性和非侵入性方法。据报道，中心主动脉压（CAP）在所选血流动力学指标中最能预测LVH。然而，很少有研究探讨CKD患者CAP的纵向变化与肾功能不全之间的关系。
对67例3 - 5期CKD患者（女性/男性比例：26/41，年龄：61.5±13.1岁）进行了5年的随访。在5年期间开始时和结束时，通过自动眼压计系统（HEM - 9000 AI；日本京都欧姆龙医疗保健公司）记录CAP。采用第二收缩期主动脉血压（SBP2）作为CAP的指标。
在整个研究过程中，收缩压（SBP）得到了良好控制。肾功能整体上随估计肾小球滤过率（eGFR）逐渐恶化。在5年观察期内，10例患者接受了肾脏替代治疗，3例患者发生了心血管疾病，2例患者被发现患有肿瘤。SBP2从120±19 mmHg升高至125±33 mmHg，eGFR从38.2±18.2 ml/min/1.73 m²降至29.5±16.3 ml/min/1.73 m²；然而，这些差异无统计学意义。左心室质量（LVM）指数从115.5±10.5 g/m²显著增加至131.2±11.7 g/m²（p < 0.05）。尽管SBP2和eGFR的变化看起来呈镜像关系，但这两个因素之间无显著相关性。此外，多因素回归分析未显示SBP2与CKD进展之间存在密切相关性。与肾功能下降相反，SBP2的基线值可预测LVM指数升高。
肾功能不全的恶化并非仅取决于血流动力学。其他因素可能以复杂的方式参与其中。
