Clinical Study Of Heart Failure In Patients Hospitalized With Chronic Kidney Disease

【Objectives】1.Explore the connection between plasma BNP levels with gender,obesity,different stages in patients with chronic kidney disease,and the diagnostic cut-off value and significance of plasma BNP level in CKD patients with heart failure.2.Analyze the incidence rate of heart failure in CKD patients and explore the influencing factors of HF and HFpEF in hospitalized CKD patients.3.Analyze the clinical features and evaluate the short-term efficacy of CKD patients with HFpEF.【Methods】1.The clinical data of 1223 patients hospitalized with CKD were analyzed retrospectively.According to the patient’s symptoms and signs of HF,BNP level and cardiac color Doppler ultrasound results the diagnoses were made,and patients were divided into HF group and not-HF group.2.Analyze the incidence of HF and compare the differences in different stages of CKD and anemia in hospitalized CKD patients.The clinical data,including baseline characteristic data,laboratory examination and so on.Using univariate and multivariate binary Logistic Regression to explore the influencing factors of HF and HFpEF in CKD patients.3.According to the left ventricular ejection fraction(LVEF),the patients with HF were divided into HFr EF group、HFmr EF group and HFpEF group.Compare the clinical data including baseline characteristic data,laboratory examination,color Doppler flow imaging of different groups to explore the clinical features of CKD patients with HFpEF.According to the clinical symptoms or signs of HF,NYHA Classification of cardiac function and plasma BNP levels to evaluate the short-term efficacy of CKD patients with HFpEF and divide these patients into Significant effect group,Effective group and Invalid group,and comare the differences between 3 group in baseline characteristic,days in Hospital and drugs consumption before and after hospitalization.Evaluate a workable short-term treatment.【Results】1.There is no significant difference in plasma BNP levels between men and women,obese and non-obese groups(P>0.05),which positive correlated with age(rs=0.241,P<0.001)and negative correlated with e GFR(rs=-0.561,P<0.001).The plasma BNP level of patients with HF in CKD stage 5 is significantly higher than that of CKD stage1～4(P<0.05).In patients do not have HF,plasma BNP levels also increase with CKD stage.The median of BNP levels in CKD Stage 1～4 are all lower than 80ng/ml while CKD stage 5 is slightly higher than that,the difference between each group is statistically significant(P<0.05).Based on the maximum value of Youden Index,the best cut-off value of plasma BNP level in CKD Stage1～4 is 86.07ng/ml,when the sensitivity is 100% and specificity is 85.5%.However,use 35.08ng/ml as the cut-off value,the sensitivity is 100%but specificity is only 61.2%.There are two cut-off value of plasma BNP level in CKD Stage 5,However,the Kappa test shows a higher Kappa value when BNP level is403.22ng/ml,which confirms to be the best cut-off value.2.There were 251 patients with HF in the study,the incidence rate of HF in hospitalized CKD patients is 20.52%,and gradually increases with CKD stages.It increased rapidly in CKD stage 3 and reached the top in CKD stage 5,which is 34.44%,the difference between group CKD Stage 5 and other groups is statistically significant(P<0.05).The incidence rate of HF is significantly higher in patients with mild and moderate anemia than that without anemia(P<0.05).But no significant difference between patients with moderate and severe anemia(P>0.05).Patients with HF are older which have longer course of disease,higher levels of SBP,DBP,plasma BNP,serum phosphate and uric acid,the proportion of patients with hypertension,diabetes,coronary heart disease,atrial fibrillation,pulmonary infection,and pulmonary hypertension is also higher while the Hb level is lower compared with patients without HF.Multivariate Logistic regression shows that age over 65(OR=2.320 、 2.288),diabetic nephropathy(OR=2.635,2.711),atrial fibrillation(OR=6.879,5.974),history of myocardial infraction(OR=7.342,8.146),pneumonia(OR=3.359,3.127),DBP(OR=1.027,1.027),pulmonary hypertension(OR=6.467,6.398),CKD stage(OR=1.593,1.615),serum phosphate(OR=1.925,1.880),UA(OR=1.002,1.002)are independent risk factors of HF in CKD patient,while Hb level is the protective factor.3.There were 224,20,and 7 patients with HFpEF,HFmr EF,and HFr EF.The most common complications in HFpEF patients are Hypertension(91.50%),Pneumonia(42.90%),Diabetes(37.50%),Pulmonary hypertension(23.70%),and Coronary heart disease(12.10%).Patients in HFpEF group are more likely to have a higher rate of hypertension,a higher level of LVPWT and IVST,but a lower rate of coronary heart disease and a lower level of BNP,Hb and LVEDD(P<0.05).No significantly differences in age,gender,primary disease,dialysis type and some other laboratory examination results(P>0.05).The median days 224 patients with HFpEF were hospitalised was 12.50,whose drug and dialysis using were significantly more than days before hospitalization(P<0.05).Evaluation of short-term efficacy showed that 22,126,and 76 patients in Significant effect group,Effective group and Invalid group,the effective rate is only 66.07%.Patients in Invalid group are older which have longer course of disease,lower BNP,SBP and DBP levels,use less ACEI/ARB and α-blocker compared with Significant effect group,the difference is statistically significant(P<0.05).No differences in other laboratory results and days of hospitalization(P>0.05).【Conclusions】1.Plasma BNP levels gradually increase by the decrase of renal function,use35ng/ml,which is the cut-off value to diagnose HF in general population,might be too low for CKD patients,especially CKD stage 5.Different diagnostic cut-off values are recommended,86ng/ml for patients in CKD stage1～4 and 403ng/ml for CKD stage 5.2.The incidence rate of HF in CKD patients were hospitalized is 20.52%.The main type of HF is HFpEF.The influencing factors of HF and HFpEF in CKD patients are same,among age over 65,diabetic nephropathy,atrial fibrillation,history of myocardial infraction,pneumonia,DBP,pulmonary hypertension,CKD stage,serum phosphate,UA are independent risk factors while Hb level is the protective factor.3.Hospitalized CKD patients with HFpEF are more likely to have a higher rate of hypertension and severe anemia,but a lower rate of coronary heart disease and level of plasma BNP.The change of ventricular is mainly in left ventricular concentric hypertrophy.The effective rate of short-term efficacy is only 66.07%.