Relationship Between The Serum 25 Hydroxyvitamin D Level And Left Ventricular Hypertrophy In Patients With Advanced Chronic Kidney Disease

Bcakgroud Chronic kidney disease(CKD)has become one of the major public problems threatening human health in the 21st century.The prevalence of CKD in China has been increasing year by year.Cardiovascular disease is treated differently in CKD complications because it is the most common complication of CKD and the leading cause of death.Many studies have found that vitamin D deficiency could greatly increase the risk of cardiovascular disease,hypertension,and type I diabetes.Vitamin D deficiency is also accompanied by increased renin and angiotensin II levels,leading to hypertension and heart hypertrophy.Vitamin D deficiency is common in CKD patients,and many studies in recent years have shown that the insufficient or deficiency of vitamin D is closely related to the disease progression of CKD patients.Chronic renal dysfunction increases the risk of cardiovascular disease.However,vitamin D-induced renal protection could indirectly reduce the risk of cardiovascular disease by delaying the progression of kidney disease.Protecting the diseased kidneys with vitamin D not only prevents the development of cardiovascular or kidney diseases,but also meets the needs of multiple vitamin D.This study will provide a theoretical basis for the treatment and prevention of LVH by retrospective analysis of the relationship between serum 25(OH)D deficiency and LVH in CKD4-5 patients,and thus effectively improves patient survival.Objective To investigate the relationship between the level of serum 25-hydroxy vitamin D[25(OH)D]and left ventricular hypertrophy(LVH)in patients with Chronic Kidney Disease4-5(CKD4-5)and analyze the related factors of LVH.Methods There were 223 CKD4-5 patients in Department of Nephrology of AnhuiProvincial Hospital between May 2016 and August 2017.The general data,laboratory tests and echocardiographic examinations were retrospectively collected.According to the recommended standard of American and European echocardiography,the Leftventricular mass index(LVMI)was used to estimate LVH.Men with LVMI(>125 g/m~2)and women with LVMI(>110 g/m~2)were the criteria for LVHdiagnosis.According to WHO,it is recommended that serum 25(OH)D concentration be less than 20ug/L as diagnostic criteria for vitamin D deficiency.The relationships between the level of serum 25(OH)D and LVMI were analyzed by correlation analysis.The binary logistic regression was used to explore the risk factors of LVH and calculate the odds ratio(OR)and 95%confidence interval(CI)for each risk factors.Further,the area under the ROC curve was used to evaluate the sensitivity and specificity of serum25(OH)D concentration to predict LVH.Results 223 cases of CKD4-5 patients included 130 cases of LVH and 93 cases of non-LVH.In 130 cases of LVH(58.3%),the LVMI were(153.39±32.72)g/m~2,and the level of serum 25(OH)D were(8.62±5.98)ug/L.In 93 cases of non-LVH(41.7%),the LVMI were(102.65±14.92)g/m~2,and the level of serum 25(OH)D were(12.83±8.33)ug/L.The level of serum 25(OH)D in LVH patients were significantly lower than that in non-LVH patients(t=4.163,P<0.001).Spearman correlation analysis showed the level of serum 25(OH)D were negatively correlated with LVMI,and the binary logistic multivariate regression analysis showed left ventricular ejection fraction(OR=0.892,95%CI 0.843~0.944,P<0.001),body index(OR=0.933,95%CI0.885~0.983,P=0.010)and serum 25(OH)D(OR=0.933,95%CI 0.885~0.983,P=0.010)were influence factors for LVH.The area under the ROC curve of serum 25(OH)D level for LVH was 0.672(95%CI 0.602-0.743,P<0.001).The sensitivity and specificity of serum 25(OH)D levels at 9.1ug/L were the highest in diagnosing left ventricular hypertrophy(Sensitivity:63.4%,Specificity:61.5%).Conclusion The serum 25(OH)D deficiency and the morbidity of LVH are common in patients with CKD 4-5,which has a negative correlation between them.The deficiency of Serum 25(OH)D is associated with increased risk of LVH in stage CKD4-5 patients.