The Correlation Between Intact Parathyroid Hormone And Left Ventricular Hypertrophy In Patients Receiving Maintenance Peritoneal Dialysis

Objectives:Cardiovascular disease is the leading cause of death in end-stage renal disease(ESRD)patients receiving maintenance peritoneal dialysis(PD).This study aimed to investigate the correlation between intact parathyroid hormone(iPTH)and left ventricular hypertrophy(LVH),and establish the predictive model of iPTH on LVH,which will give evidence for the prevention and treatment of LVH in PD patients.Methods:A cross-sectional retrospective study was conducted to study the patients who had received peritoneal dialysis for more than 6 months in Yiyang Central Hospital,Hunan Province from December 2016 to July 2020.In total,109 patients with 49 males and 60 females were included in this study.Demographic information and results of blood biochemical tests were collected.Color Doppler echocardiography was applied to investigate the structure and function of each patient’s heart.Left ventricular mass index(LVMI)of each patient was calculated according to the ratio of left ventricular mass(LVM)to body surface area(BSA).The diagnostic criteria for LVH were either LVMI≥115g/m~2 for adult males or≥95g/m~2 for adult females.According to the serum iPTH levels,patients were allocated into low iPTH(<150pg/ml)group,medium iPTH(150-300pg/ml)group,and high i PHT(>300pg/ml)group.Patients were also grouped into LVH group and non-LVH group according to the diagnosis of LVH.Spearman correlation analysis was employed to study the correlation between LVMI and impact factors.Multiple Logistic regression analysis was conducted to investigate the independent impact factors of LVH in maintenance PD patients.Receiver operating characteristic curve(ROC)of iPTH was plotted to evaluate the predictive model on LVH in maintenance PD patients.Results:1.78 patients were diagnosed with LVH,the incidence rate being 71.56%.The incidence rate in high iPTH group was significantly higher than those of medium and low iPTH groups.Spearman correlation analysis showed that iPTH levels were positively correlated to LVMI(P<0.05).2.Multiple linear regression(MLR)analysis demonstrated that serum uric acid(UA)(β=0.974,P=0.001)and serum Calcium(Ca)(β=-244.522,P=0.004)were independent impact factors of serum iPTH levels in PD patients.3.The incidence rate of hypertension,serum levels of iPTH and phosphorus(P),red cell distribution width(RDW),and neutrophil to lymphocyte ratio(NLR)in LVH group were significantly higher than those of non-LVH group(P<0.05).Spearman correlation analysis demonstrated that RDW,iPTH,NLR,hypertension,and serum phosphorus(P)levels were positively correlated to LVMI(P<0.05),whilst Hb,LVEF,ALB,LY,and serum Ca levels were inversely correlated to LVMI(P<0.05).4.Multiple Logistic regression analysis showed that elevated iPTH(OR=1.007,95%CI:1.002-1.013,P=0.005),decreased ALB(OR=0.845,95%CI:0.720-0.991,P=0.038),anemia(OR=0.948,95%CI:0.913-0.983,P=0.004),and hypertension(OR=7.035,95%CI:1.233-40.146,P=0.028)were independent impact factors of LVH in PD patients.5.The area under the receiver operating characteristic(ROC)curve of iPTH for the prediction of LVH in PD patients was 0.772(95%CI:0.683-0.860,P<0.001)with sensitivity of 61.5%,specificity of 83.9%,and Youden’s Index of 0.454.Conclusions:Elevated serum iPTH is an independent risk factor of LVH in maintenance PD patients.