Combined effects of blood pressure and glucose status on the risk of chronic kidney disease.

2024.04.26.

Toyama, M., Satoh, M., Nakayama, S. et al. Combined effects of blood pressure and glucose status on the risk of chronic kidney disease. Hypertens Res (2024). https://doi.org/10.1038/s41440-024-01683-x

　若年および中年成人における慢性腎臓病（CKD）罹患に対する血圧と血糖の複合効果を評価した。ベースライン時にCKDの既往のない60歳未満の日本人1,297,341人（男性60.1％；平均年齢41.4±9.3歳）を、共変量を用いた区間打ち切りCox比例ハザードモデルを用い検討したところ、中央値2.1年の追跡期間中に、80,187人の参加者にCKDの新規罹患がみられた。
　降圧治療（AHT）を受けていない参加者において、CKD発症に対する収縮期血圧15mmHg上昇あたりの補正ハザード比（95％信頼区間）は、正常血糖群、境界域血糖群、糖尿病群でそれぞれ1.08（1.07-1.09）、1.12（1.10-1.13）、1.15（1.12-1.18）と正常血糖群と比較して境界型血糖群および糖尿病群で有意に高かった。血圧と境界型血糖値との間の交互作用は、アウトカムの定義を蛋白尿に限定した場合に明らかであった。厳格な血圧管理は、若年・中年層における血糖値の悪い人のCKDの早期予防に重要な役割を果たすかもしれない。

This study aimed to assess the combined effects of blood pressure (BP) and glucose status on chronic kidney disease (CKD) incidence in young and middle-aged adults. We examined data from 1,297,341 Japanese individuals aged <60 years (60.1% men; mean age 41.4 ± 9.3 years) with no history of CKD at baseline. The interval-censored Cox proportional hazards model with covariates was used. During a median follow-up period of 2.1 years, new onset CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2 and/or proteinuria) occurred in 80,187 participants. In participants without antihypertensive treatment (AHT), the adjusted hazard ratios (95% confidence interval) per 1-standard deviation, that is, 15 mmHg increase in systolic BP for CKD incidence, were 1.08 (1.07–1.09), 1.12 (1.10–1.13), and 1.15 (1.12–1.18) in normoglycemia, borderline glycemia, and diabetes groups, respectively. These ratios were significantly higher in the borderline glycemia and diabetes groups compared with those in the normoglycemia group (interaction p < 0.0001). The interaction between BP and borderline glycemia was evident when the outcome definition was restricted to proteinuria. In participants under AHT, systolic BP was most strongly associated with CKD risk in the diabetes group, although no significant interaction was observed. High BP and high glucose status may synergistically increase the incidence of CKD. Strict BP management may play an important role in the early prevention of CKD in individuals with worse glucose status within the young and middle-aged population.