Increased targeting of cardiovascular risk factors in patients with chronic kidney disease does not improve atheroma burden or cardiovascular function
Increased targeting of cardiovascular risk factors in patients with chronic kidney disease does not improve atheroma burden or cardiovascular function
复制标题
DOI：
10.1016/j.ahj.2005.06.017
复制
发表时间：
2006-03-01
影响因子：
4.8
通讯作者：
Marwick, TH
中科院分区：
文献类型：
--
作者：
Isbel, NM;Haluska, B;Marwick, TH
背景：虽然多危险因素干预(MRFI)被推荐用于降低慢性肾脏病(CKD)心血管疾病(CVD)的发病率和死亡率，但其疗效尚不清楚。我们研究了MRFI计划在慢性肾脏病中的疗效。方法对200名4期或5期CKD患者进行随机对照研究，比较医生指导、护士主导的MRFI诊所(重点关注血脂异常、高同型半胱氨酸血症、血压[BP]、贫血和高磷血症)和常规护理在CKD中的作用。111名受试者完成了2年的随访期(中位随访期674天[四分位数范围348-719天])。结果MRFI组血清低密度脂蛋白胆固醇(-30.9 mg/dLvs-12.7 mg/dL，P=.001)、同型半胱氨酸(-6.95vs-0.67umol/L，P<；收缩压(-6.9vs-0.2 mm Hg，P=0.049)和舒张压(-4.8vs-1.0 mm Hg，P=0.043)。血磷和血红蛋白水平未见明显变化。尽管观察到危险因素有所改善，但IMT(-0.00比-0.01 mm，P=.533)或BAR(0.09%比0.22%，P=.834)与基线没有差异。42例患者达到CVD死亡、急性冠脉综合征、血运重建、非致命性卒中和截肢的综合终点(23例对19例，P=.475)。结论在CKD的4期或5期患者中，MRFI计划与血管结构或功能的改善无关。
Background Although multiple risk factor intervention (MRFI) is recommended to reduce the increased morbidity and mortality of cardiovascular disease (CVD) in chronic kidney disease (CKD), its efficacy is unknown. We studied the efficacy of a MRFI program in CKD.Methods This randomized controlled study of 200 patients with stage 4 or 5 CKD compared a physician-supervised, nurse-driven MRFI clinic (focused on dyslipidemia, hyperhomocysteinemia, blood pressure [BP], anemia, and hyperphosphatemia) with conventional care in CKD. One hundred eleven subjects completed 2 years of follow-up (median follow-up 674 days [interquartile range {IQR} 348-719 days]). Outcome measures were atheroma burden (carotid intimamedia thickness [IMT]) and endothelial function (brachial artery reactivity [BAR]).Results The MRFI group showed significant improvements, compared with usual care, in serum low-density lipoprotein cholesterol (-30.9 mg/dL vs -12.7 mg/dL, P = .001), homocysteine (-6.95 vs -0.67 mu mol/L, P < .001), systolic BP (-6.9 vs -0.2 mm Hg, P = .049), and diastolic BP (-4.8 vs -1.0 mm of Hg, P = .043). No significant changes were seen in serum phosphate or hemoglobin level. Despite observed improvements in risk factors, no differences from baseline were demonstrated for IMT (-0.00 vs -0.01 mm, P = .533) or BAR (0.09% vs 0.22%, P = .834). Forty-two patients reached a composite end point of CVD death, acute coronary syndrome, revascularization, nonfatal stroke, and amputation and this was similar between groups (23 vs 19 events, P = .475).Conclusions A MRFI program was not associated with improvement in vascular structure or function in stage 4 or 5 patients with CKD.