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首页> 外文期刊>Hypertension: An Official Journal of the American Heart Association >Longitudinal Blood Pressure in Late-Stage Chronic Kidney Disease and the Risk of End-Stage Kidney Disease or Mortality (Best Blood Pressure in Chronic Kidney Disease Study)Novelty and Significance
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Longitudinal Blood Pressure in Late-Stage Chronic Kidney Disease and the Risk of End-Stage Kidney Disease or Mortality (Best Blood Pressure in Chronic Kidney Disease Study)Novelty and Significance

机译：晚期慢性肾脏疾病的纵向血压和终末期肾脏疾病或死亡率的风险（慢性肾脏病研究中最佳血压）的新颖性和意义

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Whether different methods of quantitating blood pressure (BP) in late chronic kidney disease better mimic pathophysiological processes and clinical outcomes remains unclear. In a retrospective study, we determined the association of BP with end-stage kidney disease (ESKD) and all-cause mortality with BP modeled at baseline versus longitudinally with time-varying Cox models as (1) current (most recent) clinic visit, (2) lag (visit immediately preceding the current), (3) cumulative (average of previous measurements), and (4) change from baseline to the most recent. Among 1203 (6913 visits) study patients, the mean age and baseline estimated glomerular filtration rate were 66 and 18 mL·min?1·1.73 m?2), and 40% were female. Patients had a mean of 6.7 BP measurements, 540 (44.8%) reached ESKD, and 141 (11.7%) died. For systolic BP 160, current (hazard ratio [HR], 1.67), cumulative (HR, 1.58), and a rise to 160 from baseline 120 to 160 (HR, 1.60) were associated with ESKD. Similarly, diastolic BP 85 was associated with ESKD when modeled as current (HR, 1.47), lag (HR, 1.63), cumulative (HR, 2.15), or change from baseline (rise to 85 from a baseline of 60–85; HR, 1.62). Both low SBP (120), when modeled as current (HR, 1.59), cumulative exposure (HR, 1.76), persistently 120 (HR, 2.28), and high SBP (140), when modeled as cumulative exposure, were associated with all-cause mortality. For diastolic BP, only cumulative 85 was significantly associated with mortality (HR, 2.75). Thus, in late-stage chronic kidney disease, persistently high or rises in systolic BP or diastolic BP are associated with risk of ESKD, whereas baseline BP measures did not convey information on risk.
机译：尚不清楚在晚期慢性肾脏病中采用不同的量化血压（BP）的方法能否更好地模拟病理生理过程和临床结果。在一项回顾性研究中，我们确定了血压与终末期肾脏疾病（ESKD）和全因死亡率之间的相关性，基线时使用BP建模，而时变Cox模型则用纵向建模，因为（1）当前（最近）的临床就诊， （2）滞后（在当前值之前访问），（3）累积（以前的测量值的平均值），以及（4）从基线到最近的变化。在1203例（6913例访视）患者中，平均年龄和基线估计的肾小球滤过率分别为66和18 mL·min？1·1.73 m？2），其中40％为女性。患者平均测得6.7 BP，达到ESKD 540（44.8％），死亡141（11.7％）。对于收缩压> 160，电流（危险比[HR]为1.67），累积（HR为1.58），从基线120升高至160（HR为1.60）与ESKD相关。同样，当建模为当前（HR，1.47），滞后（HR，1.63），累积（HR，2.15）或从基线变化（从60-85的基线升至> 85）时，舒张压BP> 85与ESKD相关; HR，1.62）。当建模为当前（HR，1.59）时，低SBP（<120），累积暴露（HR，1.76），持续性<120（HR，2.28）和持久性SBP（> 140）（均以累积暴露为模型）均与全因死亡率相关。对于舒张压，只有累积> 85与死亡率显着相关（HR，2.75）。因此，在晚期慢性肾脏病中，收缩压或舒张压的持续升高或升高与ESKD的风险有关，而基线血压测量并未传达有关风险的信息。

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