| Objective:Cardiovascular disease(CVD)is a common complication and the main cause of death in patients with chronic kidney disease(CKD).In patients with CKD,as the disease progresses,glomerular filtration rate(GFR)decreases,resulting in decreased uric acid(UA)excretion capacity,the retention of uric acid in the body causes hyperuricemia(HUA).Recent studies have reported that HUA is an important cause of the increased incidence of CKD and an important independent risk factor for the progression of CKD,but it remains to be determined whether high level of Serum Uric Acid(SUA)is an independent risk factor for CVD or only closely related to known risk factors for CVD.The purpose of this study was to assess the distribution of SUA levels in patients with CKD at different stages,differences in SUA levels among patients with different left ventricular mass index(LVMI)levels,the risk factors of LVMI elevation were analyzed.The relationship between SUA and LVMI was compared to analyze the relationship between SUA and left ventricular hypertrophy,and the relationship between SUA and CVD was obtained,thus providing basis for the treatment and prognosis assessment of CVD in patients with CKD.Methods:This study is a cross-sectional study,Patients with non-dialysis CKD1-5 with definite diagnosis,complete medical history,laboratory indicators and echocardiography indicators were collected in the department of Nephrology of the First Affiliated Hospital of Dalian Medical University,a total of 203.And the clinical data were recorded.T-test,chi-square test,non-parametric rank sum test,Spearman rank correlation analysis and Logistic multivariate regression analysis were used to investigate the risk factors for LVMI increase in patients with non-dialysis CKD.Results:1.Serum Uric Acid(SUA)concentration in 203 non-dialysis CKD patients ranged from 59-695 mol/L,with 119 patients labeled HUA(HUA:normal purine diet,fasting SUA level twice out of the same day>420 mol/L in males or>357 mol/L in females)accounting for 58.6%,and 84 patients labeled non-HUA,accounting for 41.4%.The proportion of increased SUA among patients with different CKD stages was different(P<0.05),with the increase of CKD stage,the proportion of SUA increased gradually.The average SUA level of patients with CKD4-5 stage was higher than that of patients with CKD1-3 stage,and the difference was statistically significant(P<0.05).Male LVMI>115 g/m~2,female LVMI>95g/m~2was used as diagnostic criteria for left ventricular hypertrophy.Among the 203 patients with CKD enrolled,LVMI levels ranged from42.54 to 256.24g/m~2,with 91 patients(44.8%)with increased LVMI and 112 patients(55.2%)with normal LVMI.Patients with different CKD stages had different LVMI levels(P<0.05),and with the increase of CKD stages,the proportion of LVMI increased gradually.2.Spearman rank correlation analysis was performed on the clinical indicators with statistically significant differences between the SUA and the normal and elevated SUA groups.The results showed that SUA was positively correlated with systolic blood pressure,BNP,serum creatinine,urea nitrogen,blood phosphorus,blood potassium,total cholesterol,triglyceride,low-density lipoprotein cholesterol,urine protein quantitative,fasting blood glucose,LVMI(P<0.05).It was negatively correlated with GFR,hemoglobin,albumin,serum calcium and high-density lipoprotein cholesterol(P<0.05).3.Spearman rank correlation analysis was performed on the clinical indicators with statistically significant differences between the normal and elevated LVMI groups.The results showed that LVMI was positively correlated with systolic blood pressure,BNP,serum creatinine,urea nitrogen,serum phosphorus,serum potassium,total cholesterol,low-density lipoprotein cholesterol,urinary protein quantification and uric acid(P<0.05).It was negatively correlated with GFR,hemoglobin,serum calcium and high-density lipoprotein cholesterol(P<0.05).4.Logistic multivariate regression analysis showed that only uric acid and GFR were independent influencing factors for LVMI increase(P<0.05),while other factors such as urinary protein quantification were not.The increased risk of LVMI in patients with elevated uric acid(SUA level>420 mol/L in male;SUA level>357 mol/L in Female)was 1.014 times that in patients with normal uric acid(P=0.001,OR=1.014,OR 95%,confidence interval of 1.006-1.022).Decreased glomerular filtration rate was an independent risk factor for LVMI increase,the risk of increased LVMI in patients with GFR of 60-89ml/(min*1.73m~2),30-59ml/(min*1.73m~2),15-29 ml/(min*1.73m~2)and<15ml/(min*1.73m~2)was 3.912,4.510,6.652 and 9.885 times of those with GFR≥90 ml/(min*1.73m~2)respectively(GFR was 60-89 ml/(min*1.73m~2):P=0.031,OR=3.912,OR 95%confidence interval was 1.136-13.896;GFR was 30-59ml/(min*1.73m~2):P=0.014,OR=4.510,OR 95%confidence interval was1.383-15.403;GFR was 15-29 ml/(min*1.73m~2):P=0.019,OR=6.652,OR 95%confidence interval was 1.360-33.225;GFR was<15 ml/(min*1.73m~2):P=0.008,OR=9.885,OR 95%confidence interval was 1.878-56.677).Conclusion:1.In this study,58.6%of patients with non-dialysis CKD had increased SUA level,and with the progression of CKD,SUA level tended to increase gradually.2.Increased serum uric acid and decreased glomerular filtration rate were independent risk factors for increased LVMI level. |
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