Correlation Study Of Blood Pressure Variation In Patients With IgA Nephropathy

Objective:Objective to study the relationship between blood pressure variability and clinicopathological features in patients with IgA nephropathy(IgAN),and the correlation between insulin resistance and blood pressure variability,so as to explore the related influencing factors of abnormal rhythm of blood pressure in IgAN patients.At the same time,a large sample was used to analyze the factors affecting the abnormal blood pressure rhythm of CKD patients.It provides a certain clinical basis for the formulation of comprehensive prevention and control measures to delay the progress of chronic kidney disease and reduce the incidence of cardiovascular and cerebrovascular events.Method:STUDYI:a cross-sectional study was conducted to analyze the clinicopathological data of 114 patients with IgAN in the PLA General Hospital,and the histological grading of IgAN was evaluated by Oxford pathological classification criteria.Collection and Analysis of ABPM Data.Correlation analysis was performed by bivariate Pearson and Spearman.Logistic regression analysis was used to analyze the influencing factors of abnormal rhythm of blood pressure in IgAN patients.STUDY2:a cross-sectional study was conducted to analyze the clinical data of 846 patients with CKD in the PLA General Hospital,and logistic regression analysis was used to analyze the influencing factors of abnormal rhythm of blood pressure in CKD patients.Result:STUDY1:in 114 patients with IgAN,75.4%(86/114)patients had non dipper blood pressure rhythm and 24.6%(28/114)as dipper blood pressure rhythm.Compared with the dipper circadian rhythm in patients with non dipper circadian rhythm in patients with triglyceride(TG),nocturnal mean systolic blood pressure(NSBP)and night diastolic blood pressure(NDBP)and HOMA-IR index(HOMA-IRI)increased significantly,compared with renal pathology showed glomerular hardening stage between the two groups,no significant difference between renal pathological indexes of the rest.The results of Pearson and Spearman correlation analysis suggested TG and HOMA-IR were related to the nocturnal blood pressure,logiastic regression analysis showed that S and HOMA-IRI were important influencing factors of abnormal rhythm of blood pressure in patients with IgA nephropathy.STUDY2:668 cases of CKD patients were non dipper blood pressure rhythm,of which 173 cases were diagnosed as occult uncontrolled hypertension.Logistic regression analysis showed that age,glomerular filtration rate(eGFR)and blood uric acid for patients with CKD related factors of blood pressure rhythm abnormalities,linear regression analysis confirmed that each additional 10 years of age,eGFR ml/min and 1.73m2 per every 10 drop of blood uric acid increased by 100umol/L,while nighttime systolic blood pressure decline rate is reduced by 4%,and nocturnal diastolic blood pressure decline rate reduced by 2.8%.Conclusion:Abnormal circadian blood pressure rhythm is very common in IgAN patients,and non dipper blood pressure rhythm is directly related to glomerular segmental sclerosis and HOMA-IRI in MEST score.Age,glomerular filtration rate and serum uric acid are important factors influencing circadian blood pressure rhythm abnormalities in chronic kidney disease.Therefore,we should strengthen HOMA-IRI monitoring in patients with IgA nephropathy,especially those with advanced age,high uric acid or renal function decline.