Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico.
University of Guadalajara Health Sciences Center, Guadalajara, Mexico.
Kidney Blood Press Res. 2023;48(1):556-567. doi: 10.1159/000533438. Epub 2023 Aug 5.
In patients with chronic kidney disease stages 4 and 5 (CKD stages 4-5) without dialysis and arterial hypertension, it is unknown if the values of systolic blood pressure (SBP) considered in control (<120 mm Hg) are associated with kidney replacement therapy (KRT) and mortality.
In this retrospective cohort study, hypertensive CKD stages 4-5 patients attending the Renal Health Clinic at the Hospital Civil de Guadalajara were enrolled. We divided them into those that achieved SBP <120 mm Hg (controlled group) and those who did not (>120 mm Hg), the uncontrolled group. Our primary objective was to analyze the association between the controlled group and KRT; the secondary objective was the mortality risk and if there were subgroups of patients that achieved more benefit. Data were analyzed using Stata software, version 15.1.
During 2017-2022, a total of 275 hypertensive CKD stages 4-5 patients met the inclusion criteria for the analysis: 62 in the controlled group and 213 in the uncontrolled group; mean age 61 years; 49.82% were male; SBP was significantly lower in the controlled group (111 mm Hg) compared to the uncontrolled group (140 mm Hg); eGFR was similar between groups (20.41 mL/min/1.73 m2). There was a tendency to increase the mortality risk in the uncontrolled group (HR 6.47 [0.78-53.27]; p = 0.082) and an association by the Kaplan-Meir analysis (Log-rank p = 0.043). The subgroup analysis for risk of KRT in the controlled group revealed that patients ≥61 years had a lower risk of KRT (HR 0.87 [95% CI, 0-76-0.99]; p = 0.03, p of interaction = 0.005), but no differences were found in the subgroup analysis for mortality. In a follow-up of 1.34 years, no association was found in the risk of KRT according to the controlled or uncontrolled groups in a multivariate Cox analysis.
In a retrospective cohort of patients with CKD stages 4-5 and hypertension, SBP >120 mm Hg was not associated with risk of KRT but could be associated with the risk of death. Clinical trials are required in this group of patients to demonstrate the impact of reaching the SBP goals recommended by the KDIGO guidelines.
在没有接受透析和患有动脉高血压的慢性肾脏病 4 期和 5 期（CKD 4-5 期）患者中，血压收缩压（SBP）控制在 120mmHg 以下是否与肾脏替代治疗（KRT）和死亡率相关仍不清楚。
在这项回顾性队列研究中，我们招募了在瓜达拉哈拉市民医院肾脏保健诊所就诊的患有高血压的 CKD 4-5 期患者。我们将他们分为血压收缩压（SBP）控制在 120mmHg 以下（控制组）和血压收缩压（SBP）控制在 120mmHg 以上（未控制组）的患者。我们的主要目标是分析控制组与 KRT 之间的关联；次要目标是死亡率风险，以及是否存在获益更大的患者亚组。使用 Stata 软件，版本 15.1 进行数据分析。
2017-2022 年，共有 275 名患有高血压的 CKD 4-5 期患者符合分析标准：控制组 62 名，未控制组 213 名；平均年龄 61 岁；49.82%为男性；控制组的 SBP（111mmHg）明显低于未控制组（140mmHg）；两组间 eGFR 相似（20.41mL/min/1.73m2）。未控制组的死亡率风险呈增加趋势（HR 6.47[0.78-53.27]；p=0.082），Kaplan-Meier 分析的关联（对数秩 p=0.043）。控制组的 KRT 风险亚组分析显示，年龄≥61 岁的患者 KRT 风险较低（HR 0.87[95%CI，0-76-0.99]；p=0.03，交互作用 p=0.005），但死亡率亚组分析未发现差异。在多变量 Cox 分析中，根据控制组或未控制组进行 1.34 年的随访，未发现 KRT 风险的相关性。
在患有 CKD 4-5 期和高血压的患者的回顾性队列中，SBP＞120mmHg 与 KRT 风险无关，但可能与死亡风险相关。需要在该患者组中进行临床试验，以证明达到 KDIGO 指南推荐的 SBP 目标的影响。
