非透析慢性肾脏病患者的短期血压变异性：与疾病进展的相关性及其预后作用。

Short-term blood pressure variability in nondialysis chronic kidney disease patients: correlates and prognostic role on the progression of renal disease.

机构信息

Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, University of Campania 'Luigi Vanvitelli,' Naples.

CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.

出版信息

J Hypertens. 2018 Dec;36(12):2398-2405. doi: 10.1097/HJH.0000000000001825.

DOI:10.1097/HJH.0000000000001825

PMID:29995698

Abstract

OBJECTIVE

In chronic kidney disease (CKD), few cross-sectional studies evidenced an association between short-term BP variability (BPV) derived from ambulatory blood pressure (ABP) monitoring and renal damage. However, no study has evaluated the association of short-term BPV with the risk of CKD progression.

METHODS

We performed a cohort study to assess the correlates and the predictive value for incident renal outcomes of short-term BPV in hypertensive patients with CKD stage G1-5. As measures of short-term BPV, we considered the weighted SD (W-SD), and the coefficient of variation of SBP (CV-24-h SBP). Primary outcome was a composite endpoint of ESRD (chronic dialysis or transplantation) or GFR decline of at least 50%.

RESULTS

We included 465 patients (63.5 ± 14.2 years; 54.7% men; eGFR: 44 ± 22 ml/min per 1.73 m; proteinuria: 0.2 [0.1-0.9] g/day); W-SD, CV-24-h SBP and 24 h SBP were 12.5 ± 3.3 mmHg, 11.1 ± 2.8% and 127 ± 16 mmHg, respectively. W-SD was independently associated with older age, history of cardiovascular disease, diagnosis of diabetic, hypertensive and polycystic nephropathy, and higher 24 h SBP whereas no association with eGFR and proteinuria was found. During follow-up (median, 6.4 years), 130 patients reached the renal outcome (107 ESRD and 23 GFR decline of ≥50%). Higher 24 h, daytime and night-time SBP robustly predicted the composite renal endpoint [1.18 (1.10-1.25) for 5 mmHg], whereas BPV as measured by the W-SD did not either when expressed as a continuous variable [hazard ratio 0.97 (95% CI 0.91-1.04)] or when categorized into tertiles [1.16 (0.70-1.92) and 0.95 (0.54-1.68) in II and III tertiles, respectively]. Similar findings were found with CV-24-h SBP.

CONCLUSION

In CKD patients, short-term BPV is strongly associated with 24 h, night-time and daytime BP but is independent from the eGFR and proteinuria and does not predict CKD progression.

摘要

目的

在慢性肾脏病（CKD）中，很少有横断面研究表明来自动态血压监测（ABP）的短期血压变异性（BPV）与肾脏损害之间存在关联。然而，尚无研究评估短期 BPV 与 CKD 进展风险之间的关系。

方法

我们进行了一项队列研究，以评估高血压合并 CKD G1-5 期患者短期 BPV 与肾脏结局的相关性和预测值。作为短期 BPV 的衡量标准，我们考虑了加权标准差（W-SD）和收缩压的变异系数（24 小时收缩压的 CV-24-h SBP）。主要结局是终末期肾病（慢性透析或移植）或至少 50%肾小球滤过率下降的复合终点。

结果

我们纳入了 465 名患者（63.5±14.2 岁；54.7%为男性；eGFR：44±22ml/min/1.73m；蛋白尿：0.2[0.1-0.9]g/天）；W-SD、CV-24-h SBP 和 24 小时 SBP 分别为 12.5±3.3mmHg、11.1±2.8%和 127±16mmHg。W-SD 与年龄较大、心血管疾病史、糖尿病、高血压和多囊肾病的诊断以及更高的 24 小时 SBP 相关，而与 eGFR 和蛋白尿无关。在随访期间（中位数 6.4 年），130 名患者达到了肾脏结局（107 名终末期肾病和 23 名肾小球滤过率下降≥50%）。更高的 24 小时、白天和夜间 SBP 均能可靠地预测复合肾脏终点[每增加 5mmHg 为 1.18（1.10-1.25）]，而 W-SD 作为血压变异性的衡量标准，无论以连续变量表示[风险比 0.97（95%CI 0.91-1.04）]还是分为三分位[第 II 三分位为 1.16（0.70-1.92）和第 III 三分位为 0.95（0.54-1.68）]，均无相关性。与 24 小时收缩压的 CV-24-h SBP 相似。