Time-updated systolic blood pressure and the progression of chronic kidney disease: a cohort study.
Time-updated systolic blood pressure and the progression of chronic kidney disease: a cohort study.
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DOI：
10.7326/m14-0488
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发表时间：
2015-02-17
影响因子：
39.2
通讯作者：
Chronic Renal Insufficiency Cohort Study Investigators
中科院分区：
文献类型：
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作者：
Anderson AH;Yang W;Townsend RR;Pan Q;Chertow GM;Kusek JW;Charleston J;He J;Kallem R;Lash JP;Miller ER 3rd;Rahman M;Steigerwalt S;Weir M;Wright JT Jr;Feldman HI;Chronic Renal Insufficiency Cohort Study Investigators
慢性肾脏病（CKD）患者的血压（BP）通常控制不佳。既往关于血压水平与终末期肾病（ESRD）之间纵向相关性的报告未纳入时间更新的血压，并对已知混杂因素进行适当调整。评估基线和时间更新的收缩压（SBP）与CKD进展之间的相关性。观察性、前瞻性队列研究（ClinicalTrials.gov标识符：NCT 00304148）慢性肾功能不全队列（CRIC）研究的7个美国临床中心参与者（N= 3，708）随访中位（第25、75次随访）5.7（4.6、6.7）年。使用3次坐位SBP测量的平均值作为访视特异性SBP。将SBP时间更新为该次访视和所有既往访视的平均值。结局为ESRD和ESRD的复合肾脏终点（透析或移植）或估计肾小球滤过率（eGFR）减半。研究基线和时间更新SBP的分析分别使用传统的考克斯比例风险模型和边际结构模型。所有研究访视时，19.2%的受试者SBP ≥130 mmHg，10.6%的受试者SBP ≥140 mmHg。仅使用基线数据，SBP 130-139 mmHg与SBP <120 mmHg受试者之间ESRD的风险比（95%置信区间）为1.46（1.13-1.88），使用所有可用的时间更新数据为2.37（1.48-3.80）。在SBP ≥140 mmHg的患者中，相应的风险比分别为1.46（1.18-1.88）和3.37（2.26-5.03）。SBP每年测量一次，CRIC研究队列不是随机样本。在CRIC研究的参与者中，与基于基线SBP的分析相比，时间更新的SBP超过130 mmHg与CKD进展的相关性更强。CRIC研究由国家糖尿病、消化和肾脏疾病研究所、临床转化科学奖和其他NIH赠款的合作协议资助。
Blood pressure (BP) is often inadequately controlled in patients with chronic kidney disease (CKD). Previous reports of the longitudinal association between achieved level of BP and end-stage renal disease (ESRD) have not incorporated time-updated BP with appropriate adjustment for known confounders. To assess the association between baseline and time-updated systolic BP (SBP) with the progression of CKD. Observational, prospective cohort study (ClinicalTrials.gov identifier: NCT00304148) Seven US clinical centers Participants of the Chronic Renal Insufficiency Cohort (CRIC) Study (N=3,708) followed for a median (25th, 75th percentiles) of 5.7 (4.6, 6.7) years The mean of three seated SBP measurements were used as the visit-specific SBP. SBP was time-updated as the mean of that visit and all prior visits. Outcomes were ESRD and the composite renal endpoint of ESRD (dialysis or transplantation) or halving of the estimated glomerular filtration rate (eGFR). Analyses investigating baseline and time-updated SBP utilized traditional Cox proportional hazards models and marginal structural models, respectively. SBP was ≥130 mmHg at all study visits in 19.2% of participants, and ≥140 mmHg in 10.6%. The hazard ratio (95% confidence interval) for ESRD among participants with SBP 130–139 mmHg, compared to SBP <120 mmHg, was 1.46 (1.13–1.88) using only baseline data, and was 2.37 (1.48–3.80) using all available time-updated data. Among those with SBP ≥140 mmHg, corresponding hazard ratios were 1.46 (1.18–1.88) and 3.37 (2.26–5.03), respectively. SBP was measured once annually, and the CRIC Study cohort is not a random sample. Among participants in the CRIC Study, time-updated SBP over 130 mmHg was more strongly associated with progression of CKD than analyses based on baseline SBP. The CRIC Study is funded under cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases, Clinical Translational Science Awards, and other NIH grants.