动脉僵硬度与儿童慢性肾脏病进展。
Arterial Stiffness and Chronic Kidney Disease Progression in Children.
机构信息
Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
出版信息
Clin J Am Soc Nephrol. 2022 Oct;17(10):1467-1476. doi: 10.2215/CJN.02200222. Epub 2022 Aug 25.
BACKGROUND AND OBJECTIVES
CKD has been linked to increased arterial stiffness in adults, but data in children with CKD remain conflicting. We aimed to investigate the longitudinal dynamics and determinants of pulse wave velocity in children with CKD and its association with CKD progression.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed an analysis of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study, which prospectively followed children aged 6-17 years with CKD stages 3-5. Follow-up was censored at the time of KRT initiation. Two separate analyses were performed: with absolute pulse wave velocity (primary outcome) and with pulse wave velocity standardized to height ( score; restricted to participants ≤17 years) as a sensitivity analysis.
RESULTS
In total, 667 patients with a mean baseline eGFR of 27 ml/min per 1.73 m were included. Pulse wave velocity above the 95th percentile was observed in 124 (20%) patients at baseline. Absolute pulse wave velocity increased gradually over the median follow-up of 2.7 (interquartile range, 0.7-4.4) years, whereas pulse wave velocity score remained relatively stable. Absolute pulse wave velocity over time associated with time; older age; higher mean arterial pressure, LDL cholesterol, and albuminuria; and lower ferritin. Pulse wave velocity score (=628) was associated with the same variables and additionally, with higher diastolic BP score, lower height score, younger age, and girls. Of 628 patients, 369 reached the composite end point of CKD progression (50% eGFR loss, eGFR <10 ml/min per 1.73 m, or the start of KRT) during a median follow-up of 2.4 (interquartile range, 0.9-4.6) years. Pulse wave velocity score did not associate with CKD progression by univariable or multivariable proportional hazard analysis correcting for the established predictors eGFR, proteinuria, and BP.
CONCLUSIONS
Pulse wave velocity is increased in children with CKD but does not associate with eGFR or CKD progression.
背景与目的
CKD 与成年人动脉僵硬程度增加有关，但 CKD 患儿的数据仍存在争议。我们旨在研究 CKD 患儿脉搏波速度的纵向变化及其决定因素，并探讨其与 CKD 进展的关系。
设计、地点、参与者和测量：我们对前瞻性随访 6-17 岁 CKD 3-5 期患儿的儿童慢性肾脏病心血管合并症研究（4C 研究）进行了分析。随访时间截止于开始肾脏替代治疗（KRT）。我们进行了两项独立分析：以绝对脉搏波速度（主要结局）和以脉搏波速度标准化身高（仅限≤17 岁的参与者）为敏感性分析。
结果
共纳入 667 例 eGFR 基线值平均为 27ml/min/1.73m 的患者。基线时 124 例（20%）患者的脉搏波速度超过第 95 百分位数。中位随访 2.7（四分位距 0.7-4.4）年期间，绝对脉搏波速度逐渐升高，而脉搏波速度标准化身高 评分则相对稳定。脉搏波速度随时间变化与年龄、平均动脉压、LDL 胆固醇、白蛋白尿、铁蛋白呈正相关。脉搏波速度标准化身高 评分（=628）与上述变量相关，此外还与舒张压 评分、身高 评分、年龄、性别相关。628 例患者中，369 例在中位随访 2.4（四分位距 0.9-4.6）年内达到 CKD 进展的复合终点（eGFR 下降 50%，eGFR<10ml/min/1.73m 或开始 KRT）。单变量或多变量比例风险分析校正 eGFR、蛋白尿和血压等既定预测因素后，脉搏波速度标准化身高评分与 CKD 进展均无相关性。
结论
CKD 患儿的脉搏波速度增加，但与 eGFR 或 CKD 进展无关。
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