Reduced cortical oxygenation predicts a progressive decline of renal function in patients with chronic kidney disease
Reduced cortical oxygenation predicts a progressive decline of renal function in patients with chronic kidney disease
复制标题
DOI：
10.1016/j.kint.2017.10.020
复制
发表时间：
2018-04-01
影响因子：
19.6
通讯作者：
Burnier, Michel
中科院分区：
文献类型：
--
作者：
Pruijm, Menno;Milani, Bastien;Burnier, Michel
肾组织缺氧是慢性肾脏病（CKD）发生和进展的最终途径，但肾氧合是否能预测人类肾功能下降尚未得到证实。因此，我们进行了一项前瞻性研究，通过血氧水平依赖磁共振成像（BOLD - MRI）对112例CKD患者、47例无CKD的高血压患者和24例健康对照个体测量了肾组织氧合情况。采用12层同心物体法分析图像，该方法将肾实质分为12层等厚的部分，并报告每层的平均R2*值（高R2*值对应低氧合）以及层间R2*的变化，称为R2*斜率。收集血清肌酐值以计算估计的肾小球滤过率（MDRD eGFR）的年变化。随访时间为3年。CKD患者、高血压患者和对照个体的eGFR变化分别为-2.0、0.5和-0.2 ml/min/1.73m²/年。在对年龄、性别、糖尿病、肾素 - 血管紧张素系统（RAS）阻滞剂、eGFR和蛋白尿进行调整的多变量回归分析中，eGFR的年变化与基线24小时蛋白尿和皮质层的平均R2*值呈负相关，与R2*斜率呈正相关，但与其他协变量无关。CKD患者且外层R2*值高或R2*斜率平坦的患者发生不良肾脏结局（肾脏替代治疗或血清肌酐升高超过30%）的可能性增加三倍。因此，皮质低氧合是肾功能下降的独立预测因子。这一发现应激发探索改善肾氧合对肾脏疾病进展的治疗影响的研究。
Renal tissue hypoxia is a final pathway in the development and progression of chronic kidney disease (CKD), but whether renal oxygenation predicts renal function decline in humans has not been proven. Therefore, we performed a prospective study and measured renal tissue oxygenation by blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) in 112 patients with CKD, 47 with hypertension without CKD, and 24 healthy control individuals. Images were analyzed with the twelve-layer concentric objects method that divided the renal parenchyma in 12 layers of equal thickness and reports the mean R2* value of each layer (a high R2* corresponds to low oxygenation), along with the change in R2* between layers called the R2* slope. Serum creatinine values were collected to calculate the yearly change in estimated glomerular function rate (MDRD eGFR). Follow up was three years. The change in eGFR in CKD, hypertensive and control individuals was -2.0, 0.5 and -0.2 ml/min/1.73m(2)/year, respectively. In multivariable regression analysis adjusted for age, sex, diabetes, RAS-blockers, eGFR, and proteinuria the yearly eGFR change correlated negatively with baseline 24 hour proteinuria and the mean R2* value of the cortical layers, and positively with the R2* slope, but not with the other covariates. Patients with CKD and high outer R2* or a flat R2* slope were three times more likely to develop an adverse renal outcome (renal replacement therapy or over a 30% increase in serum creatinine). Thus, low cortical oxygenation is an independent predictor of renal function decline. This finding should stimulate studies exploring the therapeutic impact of improving renal oxygenation on renal disease progression.