Aortic Stiffness Is Independently Associated With Rate of Renal Function Decline in Chronic Kidney Disease Stages 3 and 4
Aortic Stiffness Is Independently Associated With Rate of Renal Function Decline in Chronic Kidney Disease Stages 3 and 4
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DOI：
10.1161/hypertensionaha.109.143024
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发表时间：
2010-05-01
期刊：
影响因子：
8.3
通讯作者：
Holt, Stephen G.
中科院分区：
文献类型：
--
作者：
Ford, Martin L.;Tomlinson, Laurie A.;Holt, Stephen G.
主动脉僵硬和慢性肾脏疾病由共同的危险因素和相关的心血管死亡率增加密切相关。在较低的肾功能水平，主动脉僵硬与肾小球滤过率独立相关。然而，主动脉僵硬对肾功能的纵向影响尚未见报道。133名慢性肾脏疾病3期和4期患者(估计肾小球滤过率为每1.73m(2)15~59m L/min)接受了前瞻性的动脉僵硬参数测量和肾功能监测。对120例患者进行了主动脉脉搏波速度测量。平均年龄为69+/-12岁(平均+/-SD；103名男性，30名女性，23.3%的糖尿病患者)。平均收缩压155+/-21 mm Hg，平均舒张压83+/-11 mm Hg。肾脏疾病患者的平均饮食修改估计肾小球滤过率为32+/-11毫升/分钟/1.73米(2)。肾功能的变化是使用倒数肌酐曲线图和肾功能下降25%或开始肾脏替代治疗的二分联合终点来测量的。经多因素逐步回归分析，主动脉脉搏波速度与肌酐曲线倒数梯度独立相关(r=0.46，P=0.014)。在肾功能下降25%终点或开始肾脏替代治疗的多因素分析中，独立的预测因素是主动脉脉搏波速度(r=0.48；P=0.002)、收缩压(r=0.17；P=0.039)和尿蛋白/肌酐比(r=0.2；P=0.021)。因此，我们得出结论，在慢性肾病3期和4期患者中，主动脉硬化与肾功能变化率独立相关。(高血压。2010；55：1110-1115。)
Aortic stiffness and chronic kidney disease are closely linked by shared risk factors and associated increased cardiovascular mortality. At lower levels of renal function, aortic stiffness is independently associated with glomerular filtration rate. However, the longitudinal impact of aortic stiffness on renal function has not been reported previously. A cohort of 133 patients with chronic kidney disease stages 3 and 4 (estimated glomerular filtration rate: 15 to 59 mL/min per 1.73 m(2)) underwent prospective measurement of arterial stiffness parameters and monitoring of renal function. Aortic pulse wave velocity measurement was performed in 120 patients. The mean age was 69 +/- 12 years (mean +/- SD; 103 men, 30 women, and 23.3% diabetic). Mean systolic blood pressure was 155 +/- 21 mm Hg, and mean diastolic blood pressure was 83 +/- 11 mm Hg. The mean Modification of Diet in Renal Disease estimated glomerular filtration rate was 32 +/- 11 mL/min per 1.73 m(2). Change in renal function was measured using reciprocal creatinine plots and the dichotomous combined end point of >= 25% decline in renal function or start of renal replacement therapy. After stepwise multivariate analysis, aortic pulse wave velocity was independently associated with gradient of reciprocal creatinine plot (r=0.46; P=0.014). In multivariate analysis of the end point of >= 25% decline in renal function or start of renal replacement therapy, independent predictors were aortic pulse wave velocity (r=0.48; P=0.002), systolic blood pressure (r=0,17; P=0.039), and urine protein:creatinine ratio (r=0.20; P=0.021). We, therefore, conclude that aortic stiffening is independently associated with rate of change in renal function in patients with chronic kidney disease stages 3 and 4. (Hypertension. 2010;55:1110-1115.)