Cardiac Changes In Patients With Cardiorenal Disease And The Related Study Of Its Rick Factors

Background: cardiorenal disease is the heart or kidney can not be compensated because of the dysfunction of another organ, then reinforce each other and creat a vicious cycle, eventually leading to both heart and kidney damage and failure. There are some traditional factors such as hypertension, diabetes, lipid metabolism disorders, smoking, anemia and so on, and there are also some high non-traditional factors such as hyperhomocysteinemia, Renin-angiotensin-aldosterone system activity increases, oxidative stress, ac et. All the factors reinforce each other, influence each other by the same or different mechanisms, and stack, then further speed up the organs failure such as heart, kidney and other vital organs. Realizing the physiological and pathological conditions with each other and strengthening the prevention of heart and kidney disease are of great significance to health maintenance and social burden reduction.Objective: To investigate the change characteristics of cardiac structure and function and the correlativity of its risk factors in patients with cardiarenal syndrome.Methods: Choose the patients of cardiorenal disease with renal failure from the nephrology department and cardiology department of our hospital, and divide them into CKD3,4,5 of the three groups according to the glomerular filtration rate (GFR) level, then compare among the groups on the general information, indicators, electrocardiogram tests and echocardiography.Using the SPSS 16.0, analyze the measurement data with ANOVA, and each two groups with t test. Analyze count data withχ~2 test, and skewed distribution continuous variables with rank sum test (Kruskal-Wallis method). Give the relevance analysis to the possible factors of the heart changes and then analyze the high risk factors with multiple stepwise regression.Results:1. General Information: Chronic glomerulonephritis(64 cases, 33.3%) was main in kidney disease of all the 192 patients, and hypertensive heart disease(60 cases, 31.2%) was the most type of the heart diseases. Female ratio was 1.4:1, the difference was not statistically significant (P>0.05). Age of three groups were significantly different(P<0.01), the age of the CKD5 is yonger than CKD3 and CKD4(P<0.01); Body mass index and heart rate have no significant differences among three groups(P>0.05).2. Laboratory Index: There were significant differences among three groups in creatinine, urea nitrogen, creatinine clearance rate(Ccr), GFR, hemoglobin, hematocrit, triglycerides, phosphorus, calcium phosphorus product and Parathyroid hormone(P<0.01). There were statistical differences in retinol binding protein, urine albumin, calcium, carbon dioxide combining power and blood leukocytes among three groups(P<0.05). But there were no significant difference in uric acid, 24-hour urinary protein, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein small a-JS, potassium, sodium, chlorine, high sensitive C-reactive protein, neutrophil,neutrophil percentage,Thyroid-stimulating Hormone,FT3,FT4 (P>0.05).3. Test results: There were statistically differences among three groups in left ventricular posterior wall thickness(LVPWT), left ventricular mass index(LVMI), inside diameter of ascending aorta, E peak, A peak(P<0.05). LVPWT increased in CKD5 group than CKD3 group(P<0.05). LVMI of CKD5 group increased than CKD3 and CKD4 group(P<0.05), and inside diameter of ascending aorta in CKD5 and CKD4 group was thickening than CKD3 group(P<0.05). But there were no statistically differences among three groups in other index(P>0.05). In all cases, there were 88 patients of left ventricular normal type (54.0%), 9 patients with concentric remodeling (5.5%), 19 patients with concentric hypertrophy (11.7%) and 47 patients with eccentric hypertrophy (28.8%).4. Relationship: LVPWT and serum creatinine were positively correlated (P<0.05),LVMI was positively correlated with blood urea nitrogen (P<0.05), significantly positively correlated with serum creatinine(P<0.01),and was negatively correlated with hemoglobin, triglycerides(P<0.05).Ascending aorta inside diameter has positively correlativity with the percentage of neutrophilsand parathyroid hormone(P<0.05),significantly negatively correlated with cholesterol,thyroid-stimulating hormone(P<0.01),and was negatively correlated with apolipoprotein small a-JS,HS-CRP(P<0.05).Multiple stepwise regression analysis showed that serum creatinine was independent risk factors of the changes in LVMI of Cardiorenal syndrome patients(P<0.01),and triglycerides was its independent influence factor,lipoprotein little a-JS was also an independent influence factor of the changes in ascending aorta inside diameter in patients with cardiorenal syndrome(P<0.01).Conclusion: 1. Chronic glomerulonephritis was the mainly renal disease and hypertensive heart disease was the mainly heart disease of the patients with Cardiorenal syndrome. 2. The patients with the Cardiorenal syndrome were getting younger and younger. 3. With the renal impairment increased, creatinine, urea nitrogen, phosphorus, calcium phosphorus product, PTH, retinol binding protein, urinary albumin were increased, and Ccr, GFR, hemoglobin, red blood cells hematocrit, calcium, carbon dioxide combining power, blood leukopenia were decreased. 4. Mainly changes of heart in Cardiorenal syndrome patients were thickening of left ventricular posterior wall, increases of LVMI, widening of ascending aorta inside diameter and changes of E peak and A peak. Normal left ventricle was the most common type of left ventricular geometric patterns, followed by eccentric hypertrophy, concentric remodeling and concentric hypertrophy. 5. Serum creatinine was the independent risk factor of LVMI changes,triglycerides was its independent influence factor,and lipoprotein little a-JS was also an independent influence factor of the changes in ascending aorta inside diameter in patients with Cardiorenal syndrome.