基于2012年和2021年改善全球肾脏病预后组织(KDIGO)血压目标的慢性肾脏病患者死亡率

Mortality among individuals with chronic kidney disease based on the 2012 and 2021 KDIGO blood pressure targets.

作者信息

Zou Sijue, Zhang Yan, He Xin, Cheng Jiawei, Wang Songkai, Xiong Yiwei, Peng Zhangzhe, Ao Xiang, Yuan Qiongjing

机构信息

Department of Nephrology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.

Hunan Key Laboratory of Organ Fibrosis, Central South University, Changsha, China.

出版信息

Sci Rep. 2025 Apr 18;15(1):13494. doi: 10.1038/s41598-025-91731-4.

Abstract

The 2021 Kidney Disease: Improving Global Prognosis (KDIGO) guidelines set a target systolic blood pressure (SBP) of 120 mmHg for chronic kidney disease (CKD) patients. This paper aims to compare mortality outcomes in CKD patients following the 2021 KDIGO guidelines versus the 2012 KDIGO guidelines. We used the National Health and Nutrition Examination Survey (NHANES) database to categorize CKD patients into four groups: "above 2021 KDIGO only", "above 2012 KDIGO only", "above both targets" and "controlled with both targets". We compared differences in all-cause and cardiovascular deaths among these groups. In total, 10,612 CKD patients from the 2001-2018 NHANES database were identified. Subsequently, 2,226 patients lacking mortality information and 1,157 without crucial laboratory data were excluded. 7,229 CKD patients were enrolled, with 50.67% above both targets, 27.1% controlled within both targets, 1.01% above the 2012 KDIGO target, and 21.22% only above the 2021 KDIGO target. In multivariate analyses, the risk of all-cause mortality was not statistically significant (hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.8-1.02, P = 0.11) for patients above the 2021 KDIGO target only compared to those controlled with both targets. Similar results were found for cardiovascular deaths. The 2021 KDIGO guidelines did not differentiate high-risk CKD populations in terms of all-cause death and cardiovascular death, compared with the 2012 KDIGO guidelines.

摘要

2021年《肾脏病:改善全球预后》(KDIGO)指南为慢性肾脏病(CKD)患者设定了120 mmHg的收缩压(SBP)目标。本文旨在比较遵循2021年KDIGO指南与2012年KDIGO指南的CKD患者的死亡率结果。我们使用了美国国家健康与营养检查调查(NHANES)数据库,将CKD患者分为四组:“仅高于2021年KDIGO目标”、“仅高于2012年KDIGO目标”、“高于两个目标”和“两个目标均得到控制”。我们比较了这些组之间全因死亡和心血管死亡的差异。总共从2001 - 2018年NHANES数据库中识别出10612例CKD患者。随后,排除了2226例缺乏死亡率信息的患者和1157例没有关键实验室数据的患者。纳入了7229例CKD患者,其中50.67%高于两个目标,27.1%两个目标均得到控制,1.01%高于2012年KDIGO目标,21.22%仅高于2021年KDIGO目标。在多变量分析中,仅高于2021年KDIGO目标的患者与两个目标均得到控制的患者相比,全因死亡风险无统计学意义(风险比(HR):0.91,95%置信区间(CI):0.8 - 1.02,P = 0.11)。心血管死亡情况也得到了类似结果。与2012年KDIGO指南相比,2021年KDIGO指南在全因死亡和心血管死亡方面未区分高危CKD人群。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec7b/12008221/ac5bb4d48307/41598_2025_91731_Fig1_HTML.jpg

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