Hall Michael E, Rocco Michael V, Morgan Timothy M, Hamilton Craig A, Jordan Jennifer H, Edwards Matthew S, Hall John E, Hundley William G
Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Jackson, Miss, N.C., USA; Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Miss, N.C., USA.
Division of Nephrology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, N.C., USA.
Cardiorenal Med. 2016 Aug;6(4):261-8. doi: 10.1159/000445302. Epub 2016 Apr 23.
Chronic renal hypoxia influences the progression of chronic kidney disease (CKD). Blood oxygen level-dependent (BOLD) magnetic resonance (MR) is a noninvasive tool for the assessment of renal oxygenation. The impact of beta-blockers on renal hemodynamics and oxygenation is not completely understood. We sought to determine the association between beta-blocker use, renal cortical and medullary oxygenation, and renal blood flow in patients suspected of renal artery stenosis.
We measured renal cortical and medullary oxygenation using BOLD MR and renal artery blood flow using MR phase contrast techniques in 38 participants suspected of renal artery stenosis.
Chronic beta-blocker therapy was associated with improved renal cortical (p < 0.001) and medullary (p = 0.03) oxygenation, while the use of calcium channel blockers or diuretics showed no association with either cortical or medullary oxygenation. Receipt of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with reduced medullary oxygenation (p = 0.01). In a multivariable model, chronic receipt of beta-blockers was the only significant predictor of renal tissue oxygenation (β = 8.4, p = 0.008). Beta-blocker therapy was not associated with significant changes in renal artery blood flow, suggesting that improved renal oxygenation may be related to reduced renal oxygen consumption.
In addition to known benefits to reduce cardiovascular mortality in patients with renal disease, beta-blockers may reduce or prevent the progression of renal dysfunction in patients with hypertension, diabetes, and renovascular disease, partly by reducing renal oxygen consumption. These observations may have important implications for the treatment of patients with CKD.
慢性肾缺氧影响慢性肾脏病（CKD）的进展。血氧水平依赖（BOLD）磁共振（MR）是评估肾脏氧合的一种非侵入性工具。β受体阻滞剂对肾脏血流动力学和氧合的影响尚未完全明确。我们试图确定疑似肾动脉狭窄患者使用β受体阻滞剂、肾皮质和髓质氧合以及肾血流量之间的关联。
我们对38名疑似肾动脉狭窄的参与者，采用BOLD MR测量肾皮质和髓质氧合，并采用MR相位对比技术测量肾动脉血流量。
长期使用β受体阻滞剂与肾皮质氧合改善（p < 0.001）和髓质氧合改善（p = 0.03）相关，而使用钙通道阻滞剂或利尿剂与皮质或髓质氧合均无关联。接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂与髓质氧合降低相关（p = 0.01）。在多变量模型中，长期使用β受体阻滞剂是肾组织氧合的唯一显著预测因素（β = 8.4，p = 0.008）。β受体阻滞剂治疗与肾动脉血流量的显著变化无关，提示肾氧合改善可能与肾氧消耗减少有关。
除了已知的对降低肾病患者心血管死亡率有益外，β受体阻滞剂可能部分通过减少肾氧消耗来降低或预防高血压、糖尿病和肾血管疾病患者肾功能不全的进展。这些观察结果可能对CKD患者的治疗具有重要意义。
