儿童的临床血压水平与慢性肾脏病进展：来自慢性肾脏病儿童队列的报告。
Achieved clinic blood pressure level and chronic kidney disease progression in children: a report from the Chronic Kidney Disease in Children cohort.
机构信息
Division of Nephrology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
出版信息
Pediatr Nephrol. 2021 Jun;36(6):1551-1559. doi: 10.1007/s00467-020-04833-8. Epub 2020 Nov 16.
BACKGROUND
Control of hypertension delays progression of pediatric chronic kidney disease (CKD), yet few data are available regarding what clinic blood pressure (BP) levels may slow progression.
METHODS
Longitudinal BP data from children in the Chronic Kidney Disease in Children cohort study who had hypertension or an auscultatory BP ≥ 90th percentile were studied. BP categories were defined as the maximum systolic or diastolic BP percentile (< 50th, 50th to 75th, 75th to 90th, and ≥ 90th percentile) with time-updated classifications corresponding to annual study visits. The primary outcome was time to kidney replacement therapy or a 30% decline in estimated glomerular filtration rate. Cox proportional hazard models described the effect of each BP category compared to BP ≥ 90th percentile.
RESULTS
Seven hundred fifty-four participants (median age 9.9 years at study entry) met inclusion criteria; 65% were male and 26% had glomerular CKD. Any BP < 90th percentile was associated with a decreased risk of progression for those with glomerular CKD (hazard ratio (HR), 0.63; 95% CI, 0.28-1.39 (< 50th); HR, 0.59; 95% CI, 0.28-1.26 (50th-75th); HR, 0.40; 95% CI, 0.18-0.93 (75th-90th)). Similar results were found for those with non-glomerular CKD: any BP < 90th percentile was associated with decreased risk of progression (HR, 0.78; 90% CI, 0.49-1.25 (< 50th); HR, 0.53; 95% CI, 0.33-0.84 (50th-75th); HR, 0.71; 95% CI, 0.46-1.08 (75th-90th)).
CONCLUSIONS
Achieved clinic BP < 90th percentile was associated with slower CKD progression in children with glomerular or non-glomerular CKD. These data provide guidance for management of children with CKD in the office setting. Graphical abstract.
背景
控制高血压可延缓儿科慢性肾脏病（CKD）的进展，但关于何种诊所血压（BP）水平可减缓进展的数据很少。
方法
对慢性肾脏病儿童队列研究中患有高血压或听诊 BP≥90 百分位数的儿童进行纵向 BP 数据研究。BP 类别定义为最大收缩压或舒张压百分位数（<50 百分位、50 至 75 百分位、75 至 90 百分位和≥90 百分位），时间更新分类对应于每年的研究就诊。主要结局是接受肾脏替代治疗或估计肾小球滤过率下降 30%的时间。Cox 比例风险模型描述了与 BP≥90 百分位相比，每个 BP 类别对结局的影响。
结果
754 名参与者（研究开始时的中位年龄为 9.9 岁）符合纳入标准；65%为男性，26%患有肾小球 CKD。对于肾小球 CKD 患者，任何 BP<90 百分位都与进展风险降低相关（风险比（HR），0.63；95%CI，0.28-1.39（<50 百分位）；HR，0.59；95%CI，0.28-1.26（50-75 百分位）；HR，0.40；95%CI，0.18-0.93（75-90 百分位））。对于非肾小球 CKD 患者也发现了类似的结果：任何 BP<90 百分位都与进展风险降低相关（HR，0.78；90%CI，0.49-1.25（<50 百分位）；HR，0.53；95%CI，0.33-0.84（50-75 百分位）；HR，0.71；95%CI，0.46-1.08（75-90 百分位））。
结论
在患有肾小球或非肾小球 CKD 的儿童中，达到诊所 BP<90 百分位与 CKD 进展较慢相关。这些数据为在办公室环境中管理 CKD 儿童提供了指导。
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