背景:目前尚不清楚非透析慢性肾脏病(CKD)患者的短期血压变异性(BPV)是否与靶器官损害有关。
方法:横截面,对2017年11月至2022年7月在中山大学附属第五医院肾内科住院的3442例非透析CKD患者进行单中心研究,实验室,临床血压,动态血压数据,以及通过动态血压监测(ABPM)得出的加权标准偏差(wSD)评估的短期BPV。多因素分析用于评估短期BPV与亚临床靶器官损害之间的独立影响。包括左心室肥厚(LVH),颈动脉内膜中层厚度(CIMT)异常,低估计肾小球滤过率(eGFR),和蛋白尿。
结果:参与者的平均年龄为47.53±14.06岁,56%的参与者为男性。基线eGFR为69mL/min/1.73m2。根据等数wSD的三元分布,患者分为三类T1(<9.66mmHg),T2(9.66-12.23mmHg),SBPV的T3(>12.23mmHg);T1(<8.17mmHg),T2(8.17-9.93mmHg),和DBPV的T3(>9.93mmHg)。wSD较高组患者靶器官损伤发生率高于对照组(P-趋势<0.05)。随着CKD分期的进展,短期变异性呈现增加趋势(P趋势<0.001)。多因素Logistic分析结果显示,SBPwSD的比值比(OR)为(1.07[1.03,1.11],LVH的P<0.001),(1.04[1.01,1.07,P=0.029)对于异常CIMT,(1.05[1.02,1.08],P=0.002)对于低eGFR,和(1.06[1.02,1.09],蛋白尿P=0.002);DBPwSD的OR为(1.07[1.02,1.12],对于LVH,P=0.005),(1.05[1.01,1.09],P=0.028)对于异常CIMT,(1.05[1.01,1.09],P=0.022)对于低eGFR,和(1.05[1.01,1.10],校正混杂因素和平均BP后,蛋白尿的P=0.025)。
结论:结论:短期BPV与靶器官损伤有关,对平均血压水平不负责任,中国非透析CKD参与者。
BACKGROUND: It is unclear whether short-term blood pressure variability (BPV) is associated with target organ damage in patients with non-dialysis chronic kidney disease (CKD).
METHODS: A cross-sectional, single-center study was conducted among 3442 non-dialysis CKD patients hospitalized in the department of Nephrology of the Fifth Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2022 and collected the demographic, laboratory, clinic blood pressure, ambulatory blood pressure data, and short-term BPV assessed by the weighted standard deviation (wSD) derived from ambulatory blood pressure monitoring (ABPM). Multivariate logistic analyses were used to evaluate the independent effects between short-term BPV and subclinical target organ damage, including left ventricular hypertrophy (LVH), abnormal carotid intima-media thickness (CIMT), low estimated glomerular filtration rate (eGFR), and albuminuria.
RESULTS: The average age of the participants was 47.53 ± 14.06 years and 56% of participants were male. The baseline eGFR was 69 mL/min/1.73 m2. Based on the tertile distribution of wSD according to equal numbers, patients were divided into three categories with T1(< 9.66 mmHg), T2(9.66-12.23 mmHg), and T3(> 12.23 mmHg) of SBPV; T1(< 8.17 mmHg), T2(8.17-9.93 mmHg), and T3(> 9.93 mmHg) of DBPV. The participants with the higher wSD group had a higher prevalence of target organ damage than their counterparts (P-trend < 0.05). An increasing trend in short-term variability was present with advancing CKD stages (P-trend < 0.001). Multivariate logistic analyses results showed that the odds ratio (OR) of SBP wSD was (1.07 [1.03,1.11], P < 0.001) for LVH, (1.04 [1.01,1.07, P = 0.029) for abnormal CIMT, (1.05 [1.02,1.08], P = 0.002) for low eGFR, and (1.06 [1.02,1.09], P = 0.002) for albuminuria; The OR of DBP wSD was (1.07 [1.02,1.12], P = 0.005) for LVH, (1.05 [1.01,1.09], P = 0.028) for abnormal CIMT, (1.05 [1.01,1.09], P = 0.022) for low eGFR, and (1.05 [1.01,1.10], P = 0.025) for albuminuria when adjusted for confounding factors and mean BP.
CONCLUSIONS: In conclusion, short-term BPV is associated with target organ damage, and irresponsible of average blood pressure levels, in Chinese non-dialysis CKD participants.