Prehypertension, Obesity, and Risk of Kidney Disease: 20-Year Follow-up of the HUNT I Study in Norway
Prehypertension, Obesity, and Risk of Kidney Disease: 20-Year Follow-up of the HUNT I Study in Norway
复制标题
DOI：
10.1053/j.ajkd.2009.03.023
复制
发表时间：
2009-10-01
影响因子：
13.2
通讯作者：
Hallan, Stein
中科院分区：
文献类型：
--
作者：
Munkhaugen, John;Lydersen, Stian;Hallan, Stein
背景：血压(BP)和体重对肾脏疾病风险的联合影响以前还没有研究过。为了改善高血压前期个体(即，血压120-139/80-89 mm Hg)的风险分层，我们研究了血压和体重对终末期肾脏疾病或慢性肾脏疾病(CKD)相关死亡风险的交互作用。研究设计：回溯性队列研究。地点和对象：74,986名参加北特隆德拉格第一次健康研究的成年人(参与率88%)与挪威肾脏登记和死因登记有关。预测因素：血压和体重通过标准程序测量，结果：平均收缩压和体重指数分别为136.8+/-23.3(SD)mm Hg和25.2+/-3.9 kg/m(2)，而12.9%的患者在基线时曾治疗过高血压。在21年(1,345,882人年)的中位随访期间，507名男性(1.4%)和319名女性(0.8%)开始接受肾脏替代治疗(n=157)或死于慢性肾脏病(n=669)。这些肾脏结果的多因素调整风险持续增加，而血压阈值没有降低。与体重相关的风险从体重指数25.0公斤/米开始增加(2)。在血压低于120/80毫米汞柱的参与者中，风险不会随着BMI的增加而增加。在高血压前期参与者中，BMI 18.5至24.9、25.0至29.9、30.0至34.9和35.0 kg/m(2)或更高类别的多变量调整危险比分别为1.21(95%可信区间[CI]，0.67至2.17)、1.10(95%可信区间，59至2.00)、2.66(95%可信区间，1.28至5.53)和5.94(95%可信区间，1.94~18.20)，血压低于120/80 mm Hg，BMI为18.5~24.9 kg/m(2)，趋势P=0.02。高血压患者的相应风险分别为2.13(95%可信区间，1.23~3.7)、2.4(95%可信区间，1.4~4.15)、3.32(95%可信区间，1.89~5.81)和5.53(95%可信区间，3.01~10.20)(P<；0.001)。因此，进行了二次分析，排除了研究开始后5年内经历预后的所有个体。结论：当BMI<30.0 kg/m(2)时，患有高血压前期的参与者不会增加严重肾脏结局的风险。然而，如果肥胖参与者中存在高血压前期，那么患肾脏疾病的风险就会大幅增加。Am J肾脏Dis 54：638-646。(C)2009年，由国家肾脏基金会公司提供。
Background: The combined effect of blood pressure (BP) and body weight on risk of kidney disease has not been previously studied. To improve risk stratification in prehypertensive individuals (ie, BP, 120 to 139/80 to 89 mm Hg), we examined the interaction between BP and body weight on the risk of end-stage renal disease or chronic kidney disease (CKD)-related death.Study Design: Retrospective cohort study.Setting & Participants: 74,986 adults participating in the first Health Study in Nord-Trondelag (88% participation rate) were linked to the Norwegian Renal Registry and Cause of Death Registry.Predictors: BP and body weight were measured by using standard procedures, and other relevant covariates were obtained from an extensive questionnaire.Outcome & Measurements: Hazard ratios for treated end-stage renal disease and CKD-related death were calculated.Results: Mean systolic BP and body mass index (BMI) were 136.8 +/- 23.3 (SD) mm Hg and 25.2 +/- 3.9 kg/m(2), whereas 12.9% had treated hypertension at baseline, respectively. During a median follow-up of 21 years (1,345,882 person-years), 507 men (1.4%) and 319 women (0.8%) initiated renal replacement therapy (n = 157) or died of CKD (n = 669). Multiadjusted risk of these kidney outcomes increased continuously with no lower threshold for BP. The risk associated with body weight started to increase from a BMI of 25.0 kg/m(2). In participants with BP less than 120/80 mm Hg, risk did not increase with increasing BMI. In prehypertensive participants, multivariate adjusted hazard ratios in the BMI categories 18.5 to 24.9, 25.0 to 29.9, 30.0 to 34.9, and 35.0 kg/m(2) or greater were 1.21 (95% confidence interval [CI], 0.67 to 2.17), 1.10 (95% CI, 59 to 2.00), 2.66 (95% CI, 1.28 to 5.53), and 5.94 (95% CI, 1.94 to 18.20) compared with BP less than 120/80 mm Hg and BMI of 18.5 to 24.9 kg/m(2), respectively (P = 0.02 for trend). Corresponding risks in hypertensive participants were 2.13 (95% CI, 1.23 to 3.70), 2.40 (95% CI, 1.40 to 4.15), 3.32 (95% CI, 1.89 to 5.81), and 5.53 (95% CI, 3.01 to 10.20), respectively (P < 0.001 for trend).Limitations: Baseline creatinine measurements were not available; hence, a secondary analysis was performed that excluded all individuals who experienced outcomes in the 5 years after the study start.Conclusions: Participants with prehypertension are not at increased risk of serious kidney outcomes if BMI is less than 30.0 kg/m(2). However, the risk of kidney disease increases substantially if prehypertension is present in obese participants. Am J Kidney Dis 54:638-646. (C) 2009 by the National Kidney Foundation, Inc.