Influencing Factors Of Cardiovascular Calcification And Left Ventricular Hypertrophy In Peritoneal Dialysis Patients

Objective The serum minerals and bone metabolism in patients with chronic kidney disease?CKD?entering dialysis stage were studied by current investigation,including serum calcium,phosphorus,25?OH?VitD₃,parathyroid hormone?PTH?,fibroblast growth factor 23?FGF23?.To study the related factors of cardiac valve calcification?CVC?and left ventricular hypertrophy?LVH?in dialysis patients.Research object and method1.Patients168 patients with continuous ambulatory peritoneal dialysis?CAPD?for more than three months in the nephrology ward of the First Affiliated Hospital of Anhui Medical University from October 2016 to October 2018 were selected.2.Methods?1?General data of patients were collected,such as height,weight,age,primary disease,dialysis age,body mass index?BMI?,body surface area?BSA?,blood pressure at 7 am was collected,systolic and diastolic blood pressure were recorded,mean arterial pressure was calculated and recorded.?2?Detection of laboratory indicators:hemoglobin?Hb?,serum albumin?Alb?,serum calcium,phosphorus,serum alkaline phosphatase?ALP?,triglyceride?TG?,cholesterol?total cholesterol,TC?,low density lipoprotein?LDL?,parathyroid hormone?PTH?,25.Calculate and correct calcium with hydroxyvitamin D?25?OH?VitD₃?,etc.About 2ml of morning blood was collected,and the serum fibroblast growth factor 23 level was detected by Enzyme-linked immunosorbent assay?ELISA?after centrifugation.?3?Cardiac structure and function indexes were recorded by color doppler echocardiography,including left ventricular end diastolic Diameter?LVED?,left ventricular end systolic diameter?LVES?,left ventricular posterior wall thickness?LVPWT?,interventricular septum thickness at the end of diastolic.Enddiastole?IVST?,left atrial diameter?LAD?,left ventricular ejection fraction?LVEF?were recorded.The number and location of annular calcification were recorded.Left ventricular mass index?LVMI?was calculated according to the above indexes.Left ventricular hypertrophy was judged by LVMI.?4?Patients were divided into calcification group and non-calcification group according to whether there was cardiac valve calcification.The general data,laboratory indicators and the level of fibroblast growth factor 23 were compared between calcification group and non-calcification group.The related factors of cardiac valve calcification and left ventricular hypertrophy in dialysis patients were analyzed by Spearman rank correlation analysis,and the risk factors of cardiac valve calcification and left ventricular hypertrophy were analyzed by Logistic regression.?5?According to the degree of anemia,the patients were divided into normal group,mild anemia group,moderate anemia group and severe anemia group.The incidence of CVC and LVH was compared among the groups.?6?Comparing the differences of CVC,LVH and calcium and phosphorus metabolic indices between male and female patients according to gender groups.?7?According to age,they were divided into young group,middle-aged group and old group.Calcium and phosphorus metabolic indexes,fibroblast growth factor 23,LVMI and CVC were compared among the three groups.?8?Patients were divided into hypertrophic group and non-hypertrophic group according to left ventricular hypertrophy.Calcium and phosphorus metabolic indexes and fibroblast growth factor 23 levels were compared between the two groups.?9?Spearman correlation was used to analyze the related factors of cardiac valve calcification and left ventricular hypertrophy in dialysis patients.Logistic regression was used to analyze the risk factors of cardiac valve calcification and left ventricular hypertrophy.Result?1?Among 168 patients,79?47.02%?had cardiac valve calcification and 89?52.98%?had non-calcification.The age,dialysis age,BMI,BSA,SBP,DBP,blood phosphorus,fibroblast growth factor 23 and LVMI in the heart valve calcification group were significantly higher than those in the non-calcification group?P<0.05?.?2?Heart valve calcification rate of normal group,mild anemia group,moderate anemia group and severe anemia group was P>0.05 by chi-square tests.It was considered that the incidence of heart valve calcification was the same among the four groups.The LVMI level of normal group and mild anemia group was significantly higher than that of moderate and severe anemia group?P<0.05?.Compared with mild anemia group,LVMI level in normal group had no significant difference?P>0.05?.It was considered that LVMI level was the same between the two groups.There was no significant difference in LVMI between moderate anemia group and severe anemia group?P>0.05?.?3?Calcium correction in male patients was lower than that in female patients?P<0.05?.There were 34 cases?45.95%?of male heart valve calcification and 45 cases?47.87%?of female heart valve calcification.Results P>0.05.There was no significant difference in the incidence of heart valve calcification between male and female patients.There were 58 cases of left ventricular hypertrophy in males?78.38%?and 74cases of left ventricular hypertrophy in females?78.72%?.Results P>0.05.There was no significant difference in the incidence of left ventricular hypertrophy between males and females.?4?The level of 25?OH?VitD₃ in the elderly group was significantly lower than that in the young and middle-aged groups?P<0.05?.The difference was statistically significant in elderly patients with 25?OH?VitD₃ levels.The level of FGF23 in the elderly group was significantly lower than that in the young group and the middle-aged group?P<0.05?.The difference was statistically significant.The level of FGF23 in elderly patients was different from that in young and middle-aged patients.The valence rate of heart valve in dialysis patients of different ages was significantly lower than that by P test.The difference was statistically significant.The incidence of valvular calcification was not the same among the three groups.A comparison of the two groups between the groups showed that the calcification rate of the heart valve was the highest in the elderly group and the lowest in the young group.?5?The rate of cardiac valve calcification in peritoneal dialysis patients among different age groups was significantly different?P<0.05?.It was considered that the incidence of heart valve calcification was not the same among the three groups.Two or two comparisons among the groups showed that the heart valve calcification rate was the highest in the elderly group and the lowest in the young group.?6?Serum phosphorus and fibroblast growth factor 23 in left ventricular hypertrophy group were significantly higher than those in non-left ventricular hypertrophy group?P<0.05?.?7?Spearman correlation analysis showed that cardiac valve calcification was positively correlated with age,dialysis age,BMI,BSA,systolic blood pressure,serum phosphorus,fibroblast growth factor 23 and LVMI,P<0.05,with significant difference.Multivariate logistic regression analysis showed that age?OR=1.18,P=0.042?,dialysis age?OR=1.063,P=0.036?,blood phosphorus?OR=12.86,P=0.037?,fibroblast growth factor 23?OR=1.01,P=0.008?,LVMI?OR=1.012,P=0.013?were independent risk factors for cardiac valve calcification.?8?Pearson correlation analysis showed that LVMI was positively correlated with BMI,BSA,systolic blood pressure,diastolic blood pressure,phosphorus and PTH,P<0.05,with statistical significance,and negatively correlated with Hb and Alb,P<0.05,with statistical significance.Multivariate logistic regression analysis showed that Hb?OR=0.958,P=0.002?,uric acid?OR=0.929,P=0.005?,Alb?OR=0.890,P=0.007?,blood phosphorus?OR=9.242,P=0.001?were independent risk factors for left ventricular hypertrophy in peritoneal dialysis patients.Conclusion?1?In this study,age,dialysis age,blood phosphorus,fibroblast growth factor 23 and LVMI were independent risk factors for cardiac valve calcification,and they were positively correlated with cardiac valve calcification.The age,dialysis age,blood pressure,phosphorus,fibroblast growth factor 23 and LVMI of patients with cardiac valve calcification were higher than those without cardiac valve calcification.?2?LVMI was positively correlated with BMI,BSA,systolic blood pressure,diastolic blood pressure,phosphorus and PTH,negatively correlated with Hb and Alb,and Hb,uric acid,Alb and blood phosphorus were independent risk factors for LVH.