慢性肾脏病患者就诊间血压变异性与痴呆风险的关联：一项全国性观察性队列研究
Association between visit-to-visit blood pressure variability and risks of dementia in CKD patients: a nationwide observational cohort study.
作者信息
Park Sehoon, Cho Semin, Lee Soojin, Kim Yaerim, Park Sanghyun, Huh Hyeok, Kim Yong Chul, Han Seung Seok, Lee Hajeong, Lee Jung Pyo, Joo Kwon Wook, Lim Chun Soo, Kim Yon Su, Han Kyungdo, Kim Dong Ki
机构信息
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do, Korea.
出版信息
Clin Kidney J. 2022 Jan 28;15(8):1506-1513. doi: 10.1093/ckj/sfac020. eCollection 2022 Aug.
BACKGROUND
The association between visit-to-visit blood pressure (BP) variability and dementia risk in chronic kidney disease (CKD) patients has rarely been studied.
METHODS
In this retrospective observational study, individuals who received three or more general health screenings were identified in the nationwide database of Korea. Those with persistent non-dialysis-dependent CKD [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m or dipstick albuminuria ≥1+] were included. The study exposure was systolic or diastolic BP variability, calculated as the variation independent of the mean and categorized into quartiles (Q4: the highest quartile; Q1: the lowest quartile). The risks of all-cause dementia, including Alzheimer's disease and vascular dementia, were analyzed by Cox regression adjusted for various clinical characteristics, including baseline BP and eGFR values.
RESULTS
We included 103 139 CKD patients and identified 7574 (7%) dementia events, including 5911 (6%) Alzheimer's disease cases, 886 (1%) vascular dementia events and 777 (1%) cases categorized as other types of dementia. Higher systolic BP variability was significantly associated with higher risks of all-cause dementia {[Q4 versus Q1], hazard ratio [HR] 1.173 [95% confidence interval (CI) 1.102-1.249], for trend < .001}. The results were also significant for the risk of Alzheimer's disease [HR 1.162 (95% CI 1.083-1.248), < .001] and vascular dementia [HR 1.282 (95% CI 1.064-1.545), = .039]. The results were similar when diastolic BP variability was the exposure, as high diastolic BP variability was significantly associated with higher risks of all-cause dementia [HR 1.191 (95% CI 1.117,1.270), < .001].
CONCLUSIONS
Higher visit-to-visit BP variability is significantly associated with a higher risk of dementia in CKD patients.
背景
慢性肾脏病（CKD）患者就诊间血压（BP）变异性与痴呆风险之间的关联鲜有研究。
方法
在这项回顾性观察研究中，在韩国全国性数据库中识别出接受过三次或更多次一般健康筛查的个体。纳入持续性非透析依赖性CKD患者[估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²或尿试纸白蛋白尿≥1+]。研究暴露因素为收缩压或舒张压变异性，计算为独立于均值的变异，并分为四分位数（Q4：最高四分位数；Q1：最低四分位数）。通过Cox回归分析全因痴呆风险，包括阿尔茨海默病和血管性痴呆，并对包括基线血压和eGFR值在内的各种临床特征进行校正。
结果
我们纳入了103139例CKD患者，识别出7574例（7%）痴呆事件，包括5911例（6%）阿尔茨海默病病例、886例（1%）血管性痴呆事件和777例（1%）归类为其他类型痴呆的病例。收缩压变异性越高，全因痴呆风险越高{[Q4与Q1相比]，风险比[HR]1.173[95%置信区间（CI）1.102 - 1.249]，趋势P <.001}。阿尔茨海默病风险[HR 1.162（95% CI 1.083 - 1.248），P <.001]和血管性痴呆风险[HR 1.282（95% CI 1.064 - 1.545），P = 0.039]结果也具有显著性。当以舒张压变异性为暴露因素时，结果相似，因为高舒张压变异性与全因痴呆风险显著相关[HR 1.191（95% CI 1.117,1.270），P <.001]。
结论
CKD患者就诊间血压变异性越高，痴呆风险越高。
Zotero 插件