肾功能与肾移植受者血压昼夜变化状态的关系：一项纵向研究。

Relationship between renal function and blood pressure dipping status in renal transplant recipients: a longitudinal study.

机构信息

Division of Nephrology and Hypertension, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.

Division of Transplantation and Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland.

出版信息

BMC Nephrol. 2021 Sep 30;22(1):325. doi: 10.1186/s12882-021-02523-7.

DOI:10.1186/s12882-021-02523-7

PMID:34592938

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8485467/

Abstract

BACKGROUND

Hypertension (HT) is associated with adverse outcomes in kidney transplant (KTX) recipients. Blunting of physiological decrease in nighttime compared to daytime blood pressure (non-dipping status) is frequent in this setting. However, weather non-dipping is independently associated with renal function decline in KTX patients is unknown.

METHODS

We retrospectively screened KTX outpatients attending for a routine ambulatory blood pressure monitoring (ABPM) (T1) at a single tertiary hospital. Patients had two successive follow-up visits, 1 (T2) and 2 (T3) years later respectively. Routine clinical and laboratory data were collected at each visit. Mixed linear regression models were used with estimated glomerular filtration rate (eGFR) as the dependent variable.

RESULTS

A total of 123 patients were included with a mean follow-up of 2.12 ± 0.45 years after ABPM. Mean age and eGFR at T1 were 56.0 ± 15.1 and 54.9 ± 20.0 mL/min/1.73m respectively. 61 patients (50.4%) had sustained HT and 81 (65.8%) were non-dippers. In multivariate analysis, systolic dipping status was positively associated with eGFR (p = 0.009) and compared to non-dippers, dippers had a 10.4 mL/min/1.73m higher eGFR. HT was negatively associated with eGFR (p = 0.003).

CONCLUSIONS

We confirm a high prevalence of non-dippers in KTX recipients. We suggest that preserved systolic dipping is associated with improved renal function in this setting independently of potential confounders, including HT and proteinuria. Whether modification of dipping status by chronotherapy would preserve renal function remains to be tested in clinical trials.

摘要

背景

高血压（HT）与肾移植（KTX）受者的不良结局相关。在这种情况下，夜间血压相对于白天的生理性下降（非杓型状态）减弱很常见。然而，天气非杓型状态是否与 KTX 患者的肾功能下降独立相关尚不清楚。

方法

我们回顾性筛选了在一家三级医院接受常规动态血压监测（ABPM）（T1）的 KTX 门诊患者。患者分别在 1 年（T2）和 2 年（T3）后进行了两次随访。每次就诊时均采集常规临床和实验室数据。使用混合线性回归模型，以估算肾小球滤过率（eGFR）为因变量。

结果

共纳入 123 例患者，ABPM 后平均随访 2.12±0.45 年。T1 时的平均年龄和 eGFR 分别为 56.0±15.1 和 54.9±20.0 mL/min/1.73m。61 例（50.4%）患者持续患有 HT，81 例（65.8%）为非杓型。多变量分析显示，收缩压杓型状态与 eGFR 呈正相关（p=0.009），与非杓型相比，杓型患者的 eGFR 高 10.4 mL/min/1.73m。HT 与 eGFR 呈负相关（p=0.003）。