血压控制对腹膜透析终末期肾病患者残余肾功能及透析充分性的影响

Effects of Blood Pressure Control on Residual Renal Function and Dialysis Adequacy in Patients with End-stage Renal Disease Undergoing Peritoneal Dialysis

目的探究血压控制对腹膜透析(PD)患者残余肾功能(RRF)及透析充分性的影响。方法选取2015年1月—2017年12月收治的100例PD合并高血压终末期肾病患者为研究对象,按照血压控制范围不同分为A组及B组,每组50例。A组治疗期间血压控制为120~130/70~80 mmHg,B组血压控制为130~140/80~90 mmHg。比较2组治疗前及治疗12个月后RRF指标[RRF、残肾尿素清除指数(Kt/V)、残肾肌酐清除率(Ccr)、尿量]、透析充分性(总Kt/V、总Ccr)、炎性反应[超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)]、心功能[左心室心肌质量指数(LVMI)、左心室射血分数(LVEF)]差异,并记录2组治疗期间心血管事件发生情况。结果治疗12个月后,2组RRF、残肾Kt/V、残肾Ccr、尿量、总Kt/V、总Ccr均较治疗前降低,且A组高于B组(P<0.05);2组血清hs-CRP、IL-6、LVMI均较治疗前降低,且A组低于B组(P<0.05);2组LVEF较治疗前升高,且A组高于B组(P<0.05)。A组治疗期间心血管事件总发生率低于B组(P<0.05)。结论将血压控制为120~130/70~80 mmHg,能保护PD合并高血压患者RRF,改善透析充分性,并减轻炎性反应,提高心功能,于减少心血管事件也有积极意义。

Objective To investigate the effects of blood pressure control on residual renal function(RRF)and dialysis adequacy in patients undergoing peritoneal dialysis(PD).Methods One hundred patients with end-stage renal disease combined with hypertension undergoing PD who were treated in our hospital from January 2015 to December 2017 were selected for the study.According to the control range of blood pressure,the patients were divided into group A and group B,with 50 cases in each group.The blood pressure control during treatment was 120-130/70-80 mmHg in group A,and 130-140/80-90 mmHg in group B.The RRF indexes[RRF,residual renal urea clearance index(Kt/V),residual renal creatinine clearance rate(Ccr),urine volume],dialysis adequacy(total Kt/V,total Ccr),inflammatory response hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6)and cardiac function[left ventricular myocardial mass index(LVMI),left ventricular ejection fraction(LVEF)]were compared between the two groups before treatment and in 12 months after treatment,and the occurrence of cardiovascular events during treatment were recorded in the two groups.Results In 12 months after treatment,RRF,residual renal kt/Vurea,residual renal Ccr,urine volume,total Kt/V,and total Ccr of the two groups were lower than those before treatment,and group A was higher than group B(P<0.05).Serum hs-CRP,IL-6 and LVMI were lower than those before treatment,and group A was lower than group B(P<0.05).LVEF of the two groups were higher than that before treatment,and group A was higher than group B(P<0.05).The total incidence of cardiovascular events in group A was lower than that in group B(P<0.05).Conclusion Controlling blood pressure at 120-130/70-80 mmHg can protect RRF in patients with hypertension undergoing PD,improve dialysis adequacy,reduce inflammatory response and promote cardiac function,and it has positive significance in reducing cardiovascular events.