中晚期老年慢性肾脏病患者血压控制与肾功能进展的关系  

Systolic blood pressure and progression of renal dysfunction in the elderly patients with moderate to severe chronic kidney disease： a cohort study from a tertiary hospital

作　　者：赵慧[1] 王玉[2] 孟立强[2] 张路霞[2] 王芳[2] 李晓玫[2] 

机构地区：[1] 北京大学国际医院肾内科,102206 [2]北京大学第一医院肾内科北京大学肾脏病研究所卫生部重点实验室教育部慢性肾脏病防治重点实验室,100034

出　　处：《中华内科杂志》2015年第3期181-187,共7页Chinese Journal of Internal Medicine

基　　金：卫生行业科研专项项目一泌尿系统重大疾病的防治研究（201002010）;科技部国家科技支撑计划一慢性肾脏病的早期防治（2011BA110801）

摘　　要：目的 探讨血压控制与中晚期老年慢性肾脏病（CKD）患者肾功能进展的关系.方法 前瞻性队列研究.收集2006年6月至2014年2月北京大学第一医院肾内科CKD专业门诊规律随访时间超过1年、且基线估算GFR（eGFR）为15～60 ml·min-1·1.73 m-2的老年CKD患者的临床资料,采用多因素Cox回归模型分析治疗血压控制水平对中晚期老年CKD患者肾功能进展的影响.结果 共有118例中晚期老年CKD患者纳入本研究,年龄（73.8±5.1）岁,eGFR为37.9（29.3,46.7）ml·min-1·1.73 m-2,血压（137.0±18.0）/（72.5±10.3） mmHg（1 mmHg=0.133 kPa）;随访26（12 ～94）个月,随访治疗血压（136.2±12.1）/（70.5±6.9）mmHg;血压控制率（＜140/90 mmHg）为64.4％ （76/118）.有28例患者肾功能进展.基线eGFR（HR=0.923,95％ CI0.872～0.977）和治疗收缩压水平（HR=1.504,95％ CI 1.023 ～2.212）是中晚期老年CKD患者肾功能进展的独立危险因素.与治疗收缩压≤140 mmHg比,治疗收缩压＞140 mmHg者肾功能进展危险比为2.505（95％ CI1.090 ～5.756,P=0.031）.结论 收缩压是中晚期老年CKD患者肾脏病进展的独立危险因素,临床工作中应重视对老年CKD患者的血压管理.Objective To study the effect of blood pressure （BP） control on the progression of renal function in elderly patients with chronic kidney disease （CKD） stages 3 and 4.Methods Patients aged 65 years or older in our CKD clinic with baseline CKD stages 3 and 4 and with more than one-year followup until February 2014 were included in this study.Those who had an annual loss of epidermal growth factor receptor（eGFR） for more than 5 ml ＆#183; min-1 ·1.73 m-2,or reached CKD stage 5,and/or initiated renal replacement therapy were regarded as progression of CKD.Cox regression was used to analyze the effect of BP control on the progression of CKD.Results A total of 118 patients [57 men,mean age （73.8 ± 5.1） years] were enrolled in the final analysis with median baseline eGFR of 37.9 （29.3,46.7） ml·min-1· 1.73m-2.The baseline BP was （137.0±18.0）/（72.5±10.3）mmHg（1 mmHg=0.133 kPa）.During the median 26 months （12-94 m） follow-up period,the average treated BP was （136.2 ± 12.1）/ （70.5 ±6.9）mmHg.Among all the subjects,64.4% of them reached the BP target （〈 140/90 mmHg） and 23.7% had progression of CKD.Treated systolic BP （HR =1.504,95% CI 1.023-2.212） and baseline eGFR （HR =0.923,95% CI 0.872-0.977） were independent risk factors for renal function progression in multivariate Cox analysis.Patients with treated systolic BP over 140 mmHg had higher risk to develop progression of CKD compared with those with systolic BP ≤ 140 mmHg （HR =2.505,95% CI 1.090-5.756）.Conclusions Tight blood pressure control is important in the routine care of elderly patients with CKD stage 3 and stage 4.

关 键 词：老年人 慢性肾脏病 血压 肾功能 

分 类 号：R692[医药卫生—泌尿科学]