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Year : 2018  |  Volume : 131  |  Issue : 10  |  Page : 1199-1205

Effect of Long-Term Systolic Blood Pressure Trajectory on Kidney Damage in the Diabetic Population: A Prospective Study in a Community-Based Chinese Cohort

1 School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
2 Department of Cardiology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei 063004, China
3 Department of Cardiology, Kailuan Hospital Affiliated to North China University of Science and Technology, Tangshan, Hebei 063001, China
4 Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
5 Department of Cardiology, Peking University People's Hospital, Beijing 100044, China

Correspondence Address:
Prof. Yu-Bo Fan
School of Biological Science and Medical Engineering, Beihang University, Beijing 100083
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0366-6999.231528

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Background: Previous studies have shown that hypertension is an important factor contributing to the occurrence and progression of diabetic kidney damage. However, the relationship between the patterns of blood pressure (BP) trajectory and kidney damage in the diabetic population remains unclear. This prospective study investigated the effect of long-term systolic BP (SBP) trajectory on kidney damage in the diabetic population based on an 8-year follow-up community-based cohort. Methods: This study included 4556 diabetic participants among 101,510 participants. BP, estimated glomerular filtration rate (eGFR), and urinary protein were measured every 2 years from 2006 to 2014. SBP trajectory was identified by the censored normal modeling. Five discrete SBP trajectories were identified according to SBP range and the changing pattern over time. Kidney damage was evaluated through eGFR and urinary protein value. A multivariate logistic regression model was used to analyze the influence of different SBP trajectory groups on kidney damage. Results: We identified five discrete SBP trajectories: low-stable group (n = 864), moderate-stable group (n = 1980), moderate increasing group (n = 609), elevated decreasing group, (n = 679), and elevated stable group (n = 424). The detection rate of kidney damage in the low-stable group (SBP: 118–124 mmHg) was the lowest among the five groups. The detection rate of each kidney damage index was higher in the elevated stable group (SBP: 159–172 mmHg) compared with the low-stable group. For details, the gap was 4.14 (11.6% vs. 2.8%) in eGFR <60 ml·min−1·1.73 m−2 and 3.66 (17.2% vs. 4.7%), 3.38 (25.0% vs. 7.4%), and 1.8 (10.6% vs. 5.9%) times in positive urinary protein, eGFR <60 ml·min−1·1.73 m−2 and/or positive urinary protein, and eGFR decline ≥30%, respectively (P < 0.01). Conclusion: An elevated stable SBP trajectory is an independent risk factor for kidney damage in the diabetic population.


 Abstract in Chinese





结果:我们确定了五组独立的收缩压轨迹:低阶稳定组(n=864),中阶稳定组(n=1980),中阶增高组(n=609),高阶下降组(n=679)和高阶稳定组(n=424)。低阶稳定组肾损害的检出率(收缩压为118-124mmHg)是五组中最低的。随着收缩压轨迹的增高,肾脏损伤的检出率逐渐增高。与低阶稳定组相比,高阶稳定组肾损害检出率指标(收缩压为159-172mmHg)中,EGFR<60 ml∙min-1∙1.73m-2、尿蛋白阳性,EGFR<60 ml∙min-1∙1.73m-2或尿蛋白阳性、EGFR≥下降30%分别增加了 4.14(11.6% vs 2.8%)、3.66(17.2% vs 4.7%), 3.38(25% vs 7.4%), 和1.8(10.6% vs 5.9%)倍,差异有显著统计学意义 (P<0.01)。


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