Analysis On Related Factors In Changes Of Cardiac Structure And Function Of Maintenance Hemodialysis Patients With Uremia

Background: the incidence of end-stage renal disease (ESRD) in theglobal has increased year by year, and the prognosis is poor, the high costof treatment has become the important public health problem in the world.Maintenance hemodialysis (MHD) is one of the main renal replacementtherapy method for patients with ESRD, although in recent years it hasmade great progress in the technology, but the long-term survival rate andquality of life of MHD patients is still not ideal and the long-termcomplicationsis still exist. The adverse cardiovascular event is theprimary reason that affects the prognosis of patients with ESRD.Objective: Find the changes of cardiac structure and functionthrough cardiac ultrasound examination of the MHD patients,and analyzeits risk factors. To improve the long-term survival of patients with MHDand quality of life,we should intervene the relevant risk factors witheffective ways in clinically.Methods: The patients who dialyzed in nephrological department inthe first hospital of Jilin university with cardiac ultrasound examinationbetween January2013and January2014were chosen.Select the MHDpatients according to the standard(age:18years old or more,age ofdialysis>3months,excluding those who have heart disease,tumor and acute infection disease).The total number of the patients who were chosenwas178.According to the heart changes in the results of cardiacultrasound examination,the object of study could be divided into twogroups.Records general information,the related biochemical indexes andechocardiographic results of each group.Use SPSS18.0software forstatistical analysis of data.Use chi-square test for the comparison of countdata; t test for the comparison of measurement data conforming to normaldistribution,nonparametric test for the comparison of measurement datawhich do not conforming to normal distribution,P <0.05shows that thedata is statistically different.After comparing the two groups of study,apply multiariable logistic regression analysis to the statisticallysignificant index.The index which was affected by the regressionequation was the independent risk factor of the development of cardiacstructure and function.Draw Roc curve of the independent risk factors forthe diagnosis of the heart change,we could hold the best meaningfulthreshold (sensitivity, specificity) and the corresponding area under thecurve (area under the curve, AUC) of each risk factor on cardiac structureand function change. AUC represents the diagnosis accuracy, the largerAUC shows the higher accuracy of the diagnosis.Applying the same wayof research the related factors of cardiac changes,the related factors ondiastolic function impairment in left ventricular heart which had thehighest incidence of cardiac changes were analyzed. Results: Among the178patients who dialyzed maintainly,thecardiac structure and function changes were in120cases（67.4%）. Thedecreased diastolic function of left ventricular had the lagest96cases，accounting for53.9%of the total.After using related test methods for comparison,the age of dialysis,ferritin, blood phosphorus and the calcium-phosphorus product wasstatistically different (P<0.05).Apply multiariable Logistic regressionequation to the above indexes,the age of dialysis, iron protein and bloodphosphorus were accepted by the regression equation,which showed thatthe above three indicators were independent risk factors for MHDpatients with cardiac structure and function change.Furtherly,we drawROC curve of the above three indicators in diagnosis methods predictingthe cardiac changes,the optimum threshold of diagnostic cardiac changes,the age of dialysis:36.00month（ssensitivity0.850,specificity0.655），AUC0.859；ferritin:420.00ug/L (sensitivity0.917,specificity0.469),AUC0.729;blood phosphorus:1.74mmol/L(sensitivity0.950,specificity0.655), AUC0.782.High systolic blood pressure was an independent risk factor forMHD patients with decreased left ventricular diastolic function.We drawROC curve of systolic blood pressure in diagnosis methods predicting thedecreased left ventricular diastolic function,the optimum threshold ofdiagnosis in left ventricular diastolic function decline was137.50mmHg (sensitivity0.813,specificity0.561), AUC0.737.Conclusion: The prevalence of MHD patients with cardiovasculardiseases is high,the left ventricular diastolic function impairmentoccurred mostly.High age of dialysis,high ferritin and high bloodphosphorus were independent risk factors for the cardiac changes ofMHD patients. Among MHD patients,age of dialysis≥36months,ferritin≥200ug/L or blood phosphorus≥1.74mmol/L can be as ways to predictcardiac change, and the three diagnosis methods had certain accuracy,correct judgment percentage of its heart change Respectivly:85.0%,91.7%,95.0%;correct judgment percentage of its heart changerespectively:65.5%,46.9%,65.5%.High systolic blood pressure was independent risk factor for MHDpatients with decreased left ventricular diastolic function.Systolic bloodpressure≥137.50mmHg can be used for diagnosis of left ventriculardiastolic function decline， this method has certain accuracy,correctjudgement percentage of patients with the decreased left ventriculardiastolic function was81.3%;correct judgement percentage of patientswithout the decreased left ventricular diastolic function was56.1%.