Arterial stiffness and kidney disease progression in the systolic blood pressure intervention trial .
Arterial stiffness and kidney disease progression in the systolic blood pressure intervention trial
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DOI：
10.5414/cn109982
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发表时间：
2020-07
影响因子：
1.1
通讯作者：
Supiano MA
中科院分区：
文献类型：
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作者：
Nowak KL;Chonchol M;Jovanovich A;You Z;Ambrosius WT;Cho ME;Glasser S;Lash J;Simmons DL;Taylor A;Weiner D;Rastogi A;Oparil S;Supiano MA
目的：动脉僵硬度随着年龄的增长和慢性肾脏病 (CKD) 的增加而增加，并可能导致肾功能下降，但证据不一致。我们假设，在收缩压干预试验 (SPRINT) 中，较大的基线动脉僵硬度（评估为脉压 (PP) 和颈动脉-股动脉脉搏波速度 CFPWV）与随访期（3.8 年）肾脏疾病进展独立相关。材料和方法：PP 分析中纳入了 8,815 名 SPRINT 参与者。亚组分析中纳入了 592 名参加测量 CFPWV 的 SPRINT 辅助研究的成年人。 Cox 比例风险分析用于检查 PP 与达到肾脏疾病进展终点的时间之间的关联：(A) 非 CKD 参与者的基线时估计肾小球滤过率 (eGFR) < 60 mL/min/1.73m2； (B) 基线 CKD 患者的 eGFR 下降 50%，开始透析或移植。混合模型分析检查了基线 PP/CFPWV 与后续 eGFR 的关联。结果和结论：平均±SD年龄为68±10岁，基线PP为62±14mmHg，CFPWV为10.8±2.7m/s。在完全调整的模型中，PP ≥ 中位数与肾脏疾病进展终点的风险增加相关（HR：1.93 (1.43 – 2.61)）。这种关联在没有 CKD 的个体中仍然显着 (2.05 (1.47 – 2.87))，但在基线 CKD 的个体中则不显着 (1.28 (0.55 – 2.65))。在完全调整的模型中，较高的基线 PP 与 eGFR 下降相关（p < 0.0001（所有，CKD，非 CKD）），但基线 CFPWV 则不然。在心血管事件高危老年人中，基线 PP 与肾脏疾病进展相关。
Aims: Arterial stiffness increases with both advancing age and chronic kidney disease (CKD) and may contribute to kidney function decline, but evidence is inconsistent. We hypothesized that greater baseline arterial stiffness (assessed as pulse pressure (PP) and carotid-femoral pulse-wave velocity CFPWV)) was independently associated with kidney disease progression over the follow-up period (3.8 years) in the Systolic Blood Pressure Intervention Trial (SPRINT). Materials and methods: 8,815 SPRINT participants were included in the analysis of PP. 592 adults who participated in a SPRINT ancillary study that measured CFPWV were included in subgroup analyses. Cox proportional hazards analysis was used to examine the association between PP and time to kidney disease progression endpoints: (A) incident estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2 in non-CKD participants at baseline; (B) 50% decline in eGFR, initiation of dialysis, or transplant in those with baseline CKD. Mixed model analyses examined the association of baseline PP/CFPWV with follow-up eGFR. Results and conclusion: Mean ± SD age was 68 ± 10 years, baseline PP was 62 ± 14 mmHg, and CFPWV was 10.8 ± 2.7 m/s. In the fully adjusted model, PP ≥ median was associated with an increased hazard of kidney disease progression endpoints (HR: 1.93 (1.43 – 2.61)). The association remained significant in individuals without (2.05 (1.47 – 2.87)) but not with baseline CKD (1.28 (0.55 – 2.65)). In fully adjusted models, higher baseline PP associated with eGFR decline (p < 0.0001 (all, CKD, non-CKD)), but baseline CFPWV did not. Among older adults at high risk for cardiovascular events, baseline PP was associated with kidney disease progression.