肾移植受者的动态血压轨迹和血压变异性：与慢性肾病患者的比较研究
Ambulatory blood pressure trajectories and blood pressure variability in kidney transplant recipients: a comparative study against chronic kidney disease patients.
作者信息
Korogiannou Maria, Theodorakopoulou Marieta, Sarafidis Pantelis, Alexandrou Maria Eleni, Pella Eva, Xagas Efstathios, Argyris Antonis, Protogerou Athanase, Papagianni Aikaterini, Boletis Ioannis N, Marinaki Smaragdi
机构信息
Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, National and Kapodistrian University, Medical School of Athens, Athens, Greece.
Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
出版信息
Kidney Res Clin Pract. 2022 Jul;41(4):482-491. doi: 10.23876/j.krcp.21.250. Epub 2022 Jun 22.
BACKGROUND
Hypertension is a major cardiovascular risk factor in both kidney transplant recipients (KTRs) and patients with chronic kidney disease (CKD). Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard method for hypertension management in these subjects. This is the first study evaluating the full ambulatory blood pressure (BP) profile and short-term BP variability (BPV) in KTRs versus CKD patients without kidney replacement therapy.
METHODS
Ninety-three KTRs were matched with 93 CKD patients for age, sex, and estimated glomerular filtration rate. All participants underwent 24-hour ABPM. Mean ambulatory BP levels, BP trajectories, and BPV indices (standard deviation [SD], weighted SD, and average real variability) were compared between the two groups.
RESULTS
There were no significant between-group differences in 24-hour systolic BP (SBP)/diastolic BP (DBP) (KTRs: 126.9 ± 13.1/79.1 ± 7.9 mmHg vs. CKD: 128.1 ± 11.2/77.9 ± 8.1 mmHg, p = 0.52/0.29), daytime SBP/DBP and nighttime SBP; nighttime DBP was slightly higher in KTRs (KTRs: 76.5 ± 8.8 mmHg vs. CKD: 73.8 ± 8.8 mmHg, p = 0.04). Repeated measurements analysis of variance showed a significant effect of time on both ambulatory SBP and DBP (SBP: F = [19, 3002] = 11.735, p < 0.001, partial η2 = 0.069) but not of KTR/CKD status (SBP: F = [1, 158] = 0.668, p = 0.42, partial η2 = 0.004). Ambulatory systolic/diastolic BPV indices were not different between KTRs and CKD patients, except for 24-hour DBP SD that was slightly higher in the latter group (KTRs: 10.2 ± 2.2 mmHg vs. CKD: 10.9 ± 2.6 mmHg, p = 0.04). No differences were noted in dipping pattern between the two groups.
CONCLUSION
Mean ambulatory BP levels, BP trajectories, and short-term BPV indices are not significantly different between KTRs and CKD patients, suggesting that KTRs have a similar ambulatory BP profile compared to CKD patients without kidney replacement therapy.
背景
高血压是肾移植受者（KTR）和慢性肾脏病（CKD）患者的主要心血管危险因素。动态血压监测（ABPM）被认为是这些受试者高血压管理的金标准方法。这是第一项评估KTR与未接受肾脏替代治疗的CKD患者的全天动态血压（BP）概况和短期血压变异性（BPV）的研究。
方法
93例KTR与93例CKD患者在年龄、性别和估计肾小球滤过率方面进行匹配。所有参与者均接受24小时ABPM。比较两组之间的平均动态血压水平、血压轨迹和BPV指数（标准差[SD]、加权SD和平均实际变异性）。
结果
两组之间24小时收缩压（SBP）/舒张压（DBP）无显著差异（KTR：126.9±13.1/79.1±7.9 mmHg vs. CKD：128.1±11.2/77.9±8.1 mmHg，p = 0.52/0.29），日间SBP/DBP和夜间SBP；KTR的夜间DBP略高（KTR：76.5±8.8 mmHg vs. CKD：73.8±8.8 mmHg，p = 0.04）。重复测量方差分析显示时间对动态SBP和DBP均有显著影响（SBP：F = [19, 3002] = 11.735，p < 0.001，偏η2 = 0.069），但KTR/CKD状态无显著影响（SBP：F = [1, 158] = 0.668，p = 0.42，偏η2 = 0.004）。除24小时DBP SD在后者组略高外（KTR：10.2±2.2 mmHg vs. CKD：10.9±2.6 mmHg，p = 0.04），KTR和CKD患者的动态收缩压/舒张压BPV指数无差异。两组之间的血压波动模式无差异。
结论
KTR和CKD患者的平均动态血压水平、血压轨迹和短期BPV指数无显著差异，表明与未接受肾脏替代治疗的CKD患者相比，KTR具有相似的动态血压概况。
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