Department of Internal Medicine, Nephrology and Dialysis Unit, Mansoura University Hospital, Mansoura University, Mansoura, Egypt.
Saudi J Kidney Dis Transpl. 2020 May-Jun;31(3):582-588. doi: 10.4103/1319-2442.289444.
Arterial stiffness (AS) increases progressively in patients with chronic kidney disease (CKD). It is a strong predictor of cardiovascular and all-cause mortality. This study aims at evaluate of the effect of Ramadan fasting on AS parameters, augmentation index (AIx), and pulse wave velocity (PWV) in hypertensive patients with and without CKD. A cohort of 71 patients (mean age = 57.14 ± 14.5 years, 42 females and 29 males) were enrolled in this study; 34 with CKD and 37 without CKD. All patients had hypertension, while 25 patients had diabetes mellitus. Serum creatinine (Cr), serum urea, estimated glomerular filtration rate (eGFR) by CKD-EPI formula, brachial and central systolic blood pressure (BSP and CSP respectively), brachial and central diastolic blood pressure (BDP, CDP, respectively), AIx and PWV (measured by cuff based oscillometric method) were assessed before and after Ramadan fasting. In patients without CKD BSP, BDP, CSP, and CDP significantly decreased (P = 0.0001, 0.0001, 0.0001, and 0.0001, respectively). In patients with CKD BSP and CSP significantly decreased (P = 0.005 and 0.005), while BDP and CDP decreased, but the change was not statistically significant. AIx significantly decreased in patients without CKD (P = 0.0001, mean 36.24 before and 26.22 after Ramadan fasting), but did not significantly change in patients with CKD (P 0.381 mean 25.94 before and 25 after Ramadan fasting). PWV decreased in both groups, but the change was not significant. Serum Cr significantly increased (P = 0.03 mean 1.06 mg/dL before and 1.11 mg/dL after Ramadan fasting), while eGFR did not significantly decrease (P = 0.072, mean 69.73 mL/ min/1.73 m before and 67.3 mL/min/1.73 m after Ramadan fasting) in patients without CKD. Serum Cr significantly decreased (P 0.028 mean 1.93 mg/dL before and 1.87 mg/dL after Ramadan fasting) and eGFR significantly increased (P 0.006 mean 32.65 mL/min/1.73 m before and 34.68 mL/min/1.73 m after RF) in patients with CKD. Ramadan fasting is associated with improved peripheral and central blood pressure control in hypertensive patients with and without CKD. It is also associated with improved arterial compliance (decreased AIx) in hypertensive patients without CKD.
动脉僵硬度 (AS) 在慢性肾脏病 (CKD) 患者中逐渐增加。它是心血管和全因死亡率的强有力预测指标。本研究旨在评估斋月禁食对伴有和不伴有 CKD 的高血压患者的 AS 参数、增强指数 (AIx) 和脉搏波速度 (PWV) 的影响。
一项共纳入 71 例患者（平均年龄=57.14±14.5 岁，42 名女性和 29 名男性）的队列研究，其中 34 例伴有 CKD，37 例不伴有 CKD。所有患者均患有高血压，而 25 例患有糖尿病。在斋月禁食前后评估血清肌酐 (Cr)、血清尿素、CKD-EPI 公式估算的肾小球滤过率 (eGFR)、肱动脉和中心收缩压 (BSP 和 CSP 分别)、肱动脉和中心舒张压 (BDP、CDP 分别)、AIx 和 PWV（通过袖带式振荡测量法测量）。
在不伴有 CKD 的患者中，BSP、BDP、CSP 和 CDP 显著降低（P=0.0001、0.0001、0.0001 和 0.0001）。在伴有 CKD 的患者中，BSP 和 CSP 显著降低（P=0.005 和 0.005），而 BDP 和 CDP 降低，但差异无统计学意义。不伴有 CKD 的患者 AIx 显著降低（P=0.0001，平均 36.24 在前，26.22 在后斋月禁食），但伴有 CKD 的患者 AIx 无显著变化（P=0.381，平均 25.94 在前，25 在后斋月禁食）。两组的 PWV 均降低，但差异无统计学意义。
不伴有 CKD 的患者血清 Cr 显著升高（P=0.03，平均 1.06mg/dL 在前，1.11mg/dL 在后斋月禁食），而 eGFR 无显著降低（P=0.072，平均 69.73mL/min/1.73m 在前，67.3mL/min/1.73m 在后斋月禁食）。伴有 CKD 的患者血清 Cr 显著降低（P 0.028，平均 1.93mg/dL 在前，1.87mg/dL 在后斋月禁食），eGFR 显著升高（P 0.006，平均 32.65mL/min/1.73m 在前，34.68mL/min/1.73m 在后斋月禁食）。
斋月禁食与伴有和不伴有 CKD 的高血压患者外周和中心血压控制的改善有关。它还与不伴有 CKD 的高血压患者的动脉顺应性（AIx 降低）的改善有关。
