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.
长周期收缩压轨迹对糖尿病人群肾损害的影响：一项基于社区队列的前瞻性研究摘要背景：既往研究表明，高血压是糖尿病患者肾损害发生和发展的重要因素。然而，长周期血压轨迹和糖尿病患者肾损害之间的关系尚不清楚。这是一项基于8年糖尿病随访人群的长期收缩压（SBP）轨迹对肾损伤影响的前瞻性研究。 方法：本研究包括101,510名受试者，其中4556名糖尿病患者。从2006到2014年，每两年测量该队列人群血压、血糖、肾小球滤过率（eGFR）、尿蛋白等指标，收缩压轨迹通过截尾正态模型确定。根据SBP范围和随时间变化趋势，建立五组独立的SBP轨迹。用eGFR和尿蛋白值等实验室检查指标评价肾损伤。采用多元logistic回归模型分析不同收缩压轨迹对肾脏损害的影响。 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)。 结论：高阶稳定SBP轨迹是糖尿病患者肾脏损害的独立危险因素。.
Keywords: Blood Pressure Trajectory; Diabetes with Hypertension; Kidney Damage; Longitudinal Data; Trajectory Model.