Nephrology, Dialysis and Transplantation Unit, Regional Transplant Center, Azienda Ospedaliera 'Bianchi-Melacrino-Morelli'.
Research Unit of Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR-IFC, Institute of Clinical Physiology, Reggio Calabria, Italy.
J Hypertens. 2018 Jan;36(1):119-125. doi: 10.1097/HJH.0000000000001530.
Hypertension is a risk factor for renal function loss in kidney transplant patients but there are still no longitudinal studies focusing on the relationship between ambulatory blood pressure (BP) monitoring (ABPM) and the glomerular filtration rate (GFR) evolution over time in these patients.
In a cohort of 260 renal transplant patients, we investigated the longitudinal relationship between repeated office BP measurements and simultaneous GFR measurements (on average 35 paired measurements per patient) and the relationship between baseline ABPM with the same outcome measure (by linear mixed models). Furthermore, we tested the prediction power of baseline ABPM and standardized BP measurements for a combined renal end point (GFR loss >30%, end-stage kidney disease or death) over a 3.7 years follow-up.
Longitudinal office BP measurements were inversely related with simultaneous GFR measurements and the same was true both for baseline daytime and night-time BP. (all P < 0.001). Baseline 24-h ABPM [hazard ratio (5 mmHg):1.11; 95% confidence interval 1.03-1.19] and night-time SBP [hazard ratio (5 mmHg):1.10; 95% confidence interval 1.03-1.17] predicted the combined renal end point and the predictive model based on night-time SBP provided a data-fit superior than that by daytime SBP.
In renal transplant patients, daytime and night-time SBP predict the risk of GFR loss overtime, and among the various BP metrics, night-time BP is the strongest indicator of the risk of renal function loss. Optimization of BP control and interventions targeting night-time BP may afford renal benefits in transplant patients, a hypothesis that remains to be tested in a clinical trial.
高血压是肾移植患者肾功能丧失的一个危险因素，但目前仍缺乏关注这些患者的动态血压监测（ABPM）与肾小球滤过率（GFR）随时间演变之间关系的纵向研究。
在 260 例肾移植患者的队列中，我们研究了重复诊室血压测量与同时进行的 GFR 测量（平均每位患者 35 对测量）之间的纵向关系，以及基线 ABPM 与同一结果测量之间的关系（通过线性混合模型）。此外，我们通过线性混合模型，测试了基线 ABPM 及其标准化血压测量对 3.7 年随访期间的联合肾脏终点（GFR 损失>30%、终末期肾病或死亡）的预测能力。
纵向诊室血压测量与同时进行的 GFR 测量呈负相关，日间和夜间的基础血压也是如此（均 P<0.001）。基线 24 小时 ABPM[风险比（5mmHg）：1.11；95%置信区间 1.03-1.19]和夜间 SBP[风险比（5mmHg）：1.10；95%置信区间 1.03-1.17]预测了联合肾脏终点，基于夜间 SBP 的预测模型提供了比基于日间 SBP 的模型更好的数据拟合。
在肾移植患者中，日间和夜间 SBP 预测 GFR 随时间的损失风险，在各种血压指标中，夜间 SBP 是肾功能丧失风险的最强指标。优化血压控制和针对夜间血压的干预措施可能会为移植患者带来肾脏获益，这一假说仍有待临床试验验证。
