Baek Seon Ha, Chin Ho Jun, Na Ki Young, Chae Dong-Wan, Kim Sejoong
Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Kidney Res Clin Pract. 2019 Sep 30;38(3):356-364. doi: 10.23876/j.krcp.19.030.
Few data showed the optimal blood pressure (BP) in noncritically ill patients with acute kidney injury (AKI) relative to mortality or severe AKI. We therefore sought to analyze the data that exist for the ideal target range for BP in noncritically ill patients with AKI.
We performed a retrospective cohort study involving 1,612 hospitalized patients who were diagnosed with AKI using the Kidney Disease: Improving Global Outcomes definition based on serum creatinine measurements for a period of 1 year. The average systolic BP (SBP) was categorized into 10-mmHg increments (within 48 hours after the development of AKI). The primary outcome was a composite of severe AKI or 90-day mortality.
The composite outcome rate in patients was 18.7% (302/1,612). The relationship between BP and the composite outcome followed a U-shaped curve, with an increased event rate observed at both low and high BP values. The average SBP after AKI predicted the composite outcome after adjusting for baseline variables (reference SBP: 120-129 mmHg; < 100 mmHg: hazard ratio [HR] 1.84, = 0.015; 100-109 mmHg: HR 1.56, = 0.038; 110-119 mmHg: HR 1.15, = 0.483; 130-139 mmHg: HR 1.51, = 0.045; ≥ 140 mmHg: HR 1.73, = 0.005).
Among noncritically ill patients with AKI, a U-shaped curve association was observed between the average SBP within 48 hours after AKI and the composite primary outcome of this study, with the lowest event rate for SBP ranging from approximately 110 to 129 mmHg.
很少有数据表明急性肾损伤（AKI）非危重症患者的最佳血压（BP）与死亡率或严重AKI之间的关系。因此，我们试图分析有关AKI非危重症患者理想血压目标范围的现有数据。
我们进行了一项回顾性队列研究，纳入了1612例住院患者，这些患者根据肾脏病改善全球预后（KDIGO）定义，通过血清肌酐测量在1年内被诊断为AKI。平均收缩压（SBP）按10mmHg增量进行分类（在AKI发生后的48小时内）。主要结局是严重AKI或90天死亡率的复合结局。
患者的复合结局发生率为18.7%（302/1612）。血压与复合结局之间的关系呈U形曲线，在低血压和高血压值时均观察到事件发生率增加。AKI后的平均SBP在调整基线变量后可预测复合结局（参考SBP：120 - 129mmHg；<100mmHg：风险比[HR] 1.84，P = 0.015；100 - 109mmHg：HR 1.56，P = 0.038；110 - 119mmHg：HR 1.15，P = 0.483；130 - 139mmHg：HR 1.51，P = 0.045；≥140mmHg：HR 1.73，P = 0.005）。
在AKI非危重症患者中，观察到AKI后48小时内的平均SBP与本研究的复合主要结局之间存在U形曲线关联，SBP范围约为110至129mmHg时事件发生率最低。
