Left Ventricular Diastolic Function Detection And Relevant Clinical Factors Analysis In Patients With Chronic Kidney Disease

Objective: To explore the incidence of left ventricular diastolic dysfunction inpatients with chronic kidney disease (CKD) by echocardiography and analyze therelevant clinical factors.Methods: Patients who hospitalized in nephrology department in our hospital fromMarch2012to March2013were seleted. Inclusion criteria:1.chronic kidney diseasefrom stage1to5,2. not having heart failure syndrome,3.voluntarily signed theinformed consent. Exclusion criteria:1. heart failure,2. lungs infection,3. acute renalinjury on CKD,4. persistent atrial fibrillation,5. pericardial effusion,6.Severe valvelesions,7. systemic disease such as systemic lupus erythematosus. The diagnosis andstage of CKD is based on2002K/DOQI guidelines. PHLIPIS iE33color tissue Dopplerultrasonic apparatus was used to detect left atrium diameter (LAD), Left ventricularend-diastolic diameter (LVDd), left ventricular posterior wall thickness (LVPWT), interventricular septum thickness (IVST), isovolumic relaxation time (IRT), the ratio of earlydiastolic peak velocity of mitral valve blood flow to late diastolic peak velocity ofmitral valve blood flow (E/A), the ratio of the peak early movement of mitral ring to thepeak late movement of mitral ring by tissue Doppler (E/e’). Ejection fraction (EF) andleft ventricular mass index (LVMI) were calculated according to formula. The diagnosisof left ventricular diastolic dysfunction is according to the ultrasonic diagnosis of2007European society of cardiology criteria. Biochemical indicators including totalprotein(TP), albumin(ALB), blood urea nitrogen(BUN), serum creatinine (Scr), uricacid(UA), calcium(Ca), phosphorus(P), triglyceride(TG), cholesterol(TC), high-densitylipoprotein(HDL) and low density lipoprotein(LDL) were detected by SiemensADVIA2400type automatic biochemical analyzer. Use electrical impedance to detect hemoglobin. Parathyroid hormone (PTH) was analyzed by electrochemiluminescenceimmunoassay. The expression of vitamin D receptor (VDR) in radial artery vascularsmooth muscle cells in stage5CKD patients and normal control subjects wereexamined by immunohistochemistry. SPSS13.0statistical software was used forstatistical analysis and data were expressed by x±s. The analysis of variance is appliedin differences among groups. The way of multiple sets of rate comparison is chi-square.Spearman, Pearson correlation and multiple stepwise regression were used forcorrelation analysis. Difference was statistically significant when P is less than0.05.Results:1.Total120CKD patients were included. Patients number of CKD stage1and2, stage3, stage4, stage5were30respectively.2. The incidence of left ventriculardiastolic dysfunction (DD) in CKD patients is51.7%. The incidence in different stagesof CKD is statistically significant(P＜0.05) and is highest in stage5(73.7%). DDexisted in the early stage of CKD and the incidence increased with the development ofCKD. The severity of DD was also increased with the development of CKD.3.Ultrasonic results showed that the incidence of left ventricular hypertrophy in differentstage of CKD is statistically significant(P＜0.05). The incidence of left ventricularhypertrophy is highest in stage5. Left ventricular hypertrophy is a common cardiacstructural lesion in advanced CKD.4. Patients were divided into two groups accordingto diastolic function: normal group and DD group. Systolic blood pressure and diastolicblood pressure in DD group were higher normal group. eGFR and Hb in DD group wereapparently lower than normal group. Differences were statistical significance(P＜0.05).The differences of basic information in two groups such as age, Alb, TC, TG, HDL andLDL were not statistically significant (P＞0.05). Incidence of left ventricularhypertrophy between the two groups was statistically significant (P＜0.05). Incidenceof diabetes between the two groups was statistically significant (P＜0.05).5. Singlefactor correlation analysis showed that E/e’ is negatively correlated with eGFR and Hb.E/e’ was positively correlated with systolic blood pressure, P and Ca×P. Multiplestepwise regression analysis showed that E/e’ is negatively correlated with eGFR andpositively correlated with LVMI, systolic blood pressure, age and TG.6.VDRexpression in radial artery vascular smooth muscle cells in stage5CKD patients wasmuch lower compared with normal control groups (8.21%±7.38%vs24.09%±7.04%, P Conclusion: The incidence of DD is notable in CKD. DD exists in the early stage ofCKD, both the incidence and the severity of DD increased with the development ofCKD. The decrease of eGFR, hyperphosphatemia, anemia, left ventricular hypertrophy,hypertension, age and diabetes are possible risk factors of DD in CKD. The decrease ofVDR expression in CKD may attribute to DD. Therefore, left ventricular diastolicfunction should be detected early, diagnose early and treat early in CKD patients, so asto reduce cardiovascular disease mortality in CKD.