高血压是慢性肾脏病患者最为常见的共病。但是，肾脏病检测指标——估算肾小球滤过率（eGFR）和白蛋白尿——与死亡或终末期肾脏病（ESRD）的关联是否因高血压的存在与否而不同，目前尚属未知。

最近发表于《TheLancet》的一项荟萃分析显示，无论有无高血压，慢性肾脏病均应被视为与死亡和ESRD相关的重要危险因素。

根据慢性肾脏病预后联盟（CKD-PC）的标准选择研究，进行荟萃分析。数据传输和分析于2011年3月至2012年6月之间完成。对有或无高血压的个体，使用 Cox 比例风险模型，评估与eGFR及白蛋白尿相关的死亡和ESRD的风险比（HR）。

研究分析了来自45个队列入群（25个普通人群，7个高危人群和13个慢性肾脏病人群）1 127 656例受试者的数据。结果发现：其中364 344例患有高血压。在普通人群和高危人群中，无论是否患有高血压，低eGFR和高白蛋白尿与死亡相关。eGFR正常的高血压个体的全因死亡风险为无高血压个体的1.1～1.2倍。eGFR在45～75 ml/（min.1.73m2）的无高血压个体与高血压个体相比相对风险的斜度更陡，因此较低eGFR的个体死亡风险相同。以eGFR 95 ml/（min.1.73m2）作为每组的参照准确评估交互作用，eGFR为45 ml/（min.1.73m2）的无高血压个体和高血压个体的校正全因死亡HR分别为1.77（95%CI 1.57～1.99）和1.24（95%CI 1.11～1.39）（总体交互P=0.000 3）。同样，以白蛋白/肌酐比值（ACR）5 mg/g作为参照，ACR为300 mg/g的无高血压个体和高血压个体的全因死亡HR分别为2.30（95%CI 1.98～2.68）和2.08（95%CI 1.84～2.35）（总体交互P=0.019）。对于心血管疾病死亡，得出了同样的结果。然而，eGFR和白蛋白尿与ESRD的关联不因有无高血压而不同。慢性肾脏病人群的结果与普通人群和高危人群的相似。

Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis.

Lancet. 2012 Nov 10;380(9854):1648.

Abstract

BACKGROUND:

Hypertension is the most prevalent comorbidity in individuals with chronic kidney disease. However, whether the association of the kidney disease measures, estimated glomerular filtration rate (eGFR) and albuminuria, with mortality or end-stage renal disease (ESRD) differs by hypertensive status is unknown.

METHODS:

We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and ESRD associated with eGFR and albuminuria in individuals with and without hypertension.

FINDINGS:

We analysed data for 45 cohorts (25 general population, seven high-risk, and 13 chronic kidney disease) with 1,127,656 participants, 364,344 of whom had hypertension. Low eGFR and high albuminuria were associated with mortality irrespective of hypertensive status in the general population and high-risk cohorts. All-cause mortality risk was 1·1-1·2 times higher in individuals with hypertension than in those without hypertension at preserved eGFR. A steeper relative risk gradient in individuals without hypertension than in those with hypertension at eGFR range 45-75 mL/min per 1·73 m(2) led to much the same mortality risk at lower eGFR. With a reference eGFR of 95 mL/min per 1·73 m(2) in each group to explicitly assess interaction, adjusted HR for all-cause mortality at eGFR 45 mL/min per 1·73 m(2) was 1·77 (95% CI 1·57-1·99) in individuals without hypertension versus 1·24 (1·11-1·39) in those with hypertension (p for overall interaction=0·0003). Similarly, for albumin-creatinine ratio of 300 mg/g (vs 5 mg/g), HR was 2·30 (1·98-2·68) in individuals without hypertension versus 2·08 (1·84-2·35) in those with hypertension (p for overall interaction=0·019). We recorded much the same results for cardiovascular mortality. The associations of eGFR and albuminuria with ESRD, however, did not differ by hypertensive status. Results for chronic kidney disease cohorts were similar to those for general and high-risk population cohorts.

INTERPRETATION:

Chronic kidney disease should be regarded as at least an equally relevant risk factor for mortality and ESRD in individuals without hypertension as it is in those with hypertension.