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2021年腎臓病の現実世界での採用: グローバルな成果の改善 慢性腎臓病における血圧ガイドライン
Hyeok-Hee Lee1, So Mi Jemma Cho2,3,4, Cian P McCarthy5,6
1Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Journal of the American Society of Nephrology : JASN
|February 20, 2026
まとめ
2021年腎臓病:グローバルアウトカム改善 (KDIGO) 慢性腎臓病 (CKD) の血圧 (BP) ガイドラインは,現実世界の採用が限られていることを示しています. 2024年現在,ほとんどのCKD患者は,推奨される静脈動脈BP目標値を超えているままです.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 心臓病学 心臓病学
- クリニカル・プラクティスのガイドライン
- 公衆衛生は公衆衛生である.
背景:
- "2021年腎臓病:グローバルアウトカム改善 (KDIGO) ガイドライン"では,慢性腎臓病 (CKD) の患者に対して,低血圧 (BP) 目標値 (<120 mmHg) を推奨しています.
- この更新されたガイドラインの実際の実施と臨床実務への影響は,ほとんど未検討のままである.
研究 の 目的:
- CKD第3~4段階の患者における2021年KDIGOシストリックBP目標の採用率を評価する.
- 2021年のKDIGOシストリックBP目標への遵守と臨床結果との関連性を評価する.
主な方法:
- マス・ゼネラル・ブリガム保健医療ネットワークのCKDステージ3〜4の患者約5万人を対象に,2020年から2024年まで毎年連続した横断分析を行った.
- インシデントCKDステージ3-4 (2014-2019) の18,996人の患者を縦断的に分析し,2021年のKDIGOターゲットに相対してシストリックBPに基づいて臨床結果を評価しました.
主要な成果:
- ガイドライン前 (2020年) において,CKD患者の18.3%がシストリックBP目標を達成しました. ガイドライン以降,採用はわずかに増加し,2024年までに21.9%に達した.
- 2021年のKDIGO目標値を超える静脈動脈血圧を有する患者は,心臓・腎臓障害のリスクが増加したが,低血圧のリスクは低かった.
- 他の安全性エンドポイントにおける有意な差異は,ターゲットシストリックBPの範囲内の患者と,上記の患者間で観察されなかった.
結論:
- 2021年のCKD患者のためのKDIGO血圧ガイドラインの現実世界の採用は限られている.
- 2024年には,CKD患者の大多数 (約80%) がまだ推奨される静脈動脈BP目標値を超えていた.
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