A Preliminary Study On The Relationship Between ALP And Left Ventricular Hypertrophy In Patients With Stage 3-5 CKD

[Objective]By collecting clinical data of patients with stage 3-5 chronic kidney disease in our hospital,the incidence and influencing factors of left ventricular hypertrophy in patients with chronic kidney disease were retrospectively analyzed,the changes and significance of alkaline phosphatase in patients with left ventricular hypertrophy were preliminarily discussed.[Methods]A cross-sectional study was conducted to collect 313 adult patients with stage 3-5 chronic kidney disease admitted to the first affiliated hospital of suzhou university from January 2017 to June 2018.Patients' gender,age,blood pressure,body mass index,use of antihypertensive drugs and other basic information were recorded.Ca,P,BUN,Scr,ALP,UA,ALB,HSCRP,ALT,AST,TG,TC,LDL-C,and PTH were detected in serum of all groups.Leukocyte count,lymphocyte count,neutrophil count,and hemoglobin were analyzed by hematology analyzer,I VST,LVPWT,LVDd,and EF%were collected.CKD3 stage GFR30-59mL/(min·1.73m2),CKD4 stage GFR 15-29mL/(min·1.73m2)and CKD5 stage GFR<15ml/(min·1.73m2)were grouped according to the chronic kidney disease K/DOQI guidelines.The reference range of alkaline phosphatase in our hospital is 45-125U/L,and the median is 84.80U/L.According to the median,it is further grouped into ALP?84.80U/L and ALP>84.80U/L.The clinical data was analyzed by the statistical software SPSS 17.0.Measurement data with normal distribution was expressed by mean±standard deviation,and the mean of the groups were compared by one-way anova;measurement data with the skewness distribution was expressed by median and interquartile,and compared by rank-sum test;count data to the number of cases between the three groups were compared by chi-square test.Spearman and Pearson correlation methods were used to analyze the relationship between left ventricular hypertrophy and HGB,ALP,HSCRP,PTH and other factors,and multivariate logistic regression was used to analyze independent risk factors of LVH.The receiver-operator characteristic(ROC)curve was plotted to evaluate the performance of ALP in diagnosing left ventricular hypertrophy.[Result](1)Periods in patients with chronic kidney disease(CKD)in blood pressure,give priority to with systolic blood pressure,and increased,with the decline in renal function in patients with stage CKD3,CKD4 and CKD5 average systolic blood pressure(136.45±20.98)mmHg,(141.66±23.33)mmHg,(149.31±25.67)mmHg,comparing statistical differences between groups,P=0.001,are compared two stage CKD5 and CKD3,CKD4 is statistically significant,(P<0.001,0.034,separately).Between CKD3 stage and CKD4 stage,no difference was found,(P>0.05).However,there was no difference in the comparison of mean diastolic blood pressure among patients at all stages.(2)All patients with chronic kidney disease have anemia of varying degrees.With the decrease of renal function,the degree of anemia becomes more and more serious,and the degree of anemia of patients with left ventricular hypertrophy in all stages is more serious than that of patients without left ventricular hypertrophy.In patients with CKD3,CKD4 and CKD5 stage of left ventricular hypertrophy,the mean value of hemoglobin was(118.79±17.14)g/L,(104.31±20.22)g/L,and(88.40±17.53)g/L,there were differences between groups,(P<0.001).(3)The serum calcium level of patients with left ventricular hypertrophy at each stage was lower than that of patients without left ventricular hypertrophy,but all of them were within the normal range,with no statistical significance.With the decrease of renal function,there was an upward trend of blood phosphorus.In patients with CKD5 stage combined with left ventricular hypertrophy,the highest median blood phosphorus reached 1.65mmol/L,and there were statistical differences between the patients with left ventricular hypertrophy,P<0.01,and the comparison between the two groups was statistically significant,(P<0.05).The serum alkaline phosphatase of patients with left ventricular hypertrophy was higher than that of patients without left ventricular hypertrophy,(P<0.05),but there was no difference in patients at all stages(P>0.05).There is no difference between alanine aminotransferase and aspartate aminotransferase.With the decrease of renal function,parathyroid hormone increased significantly,and the level of parathyroid hormone in patients with left ventricular hypertrophy at all stages was higher than that in patients without left ventricular hypertrophy.The median PTH of patients with CKD3,CKD4 and CKD5 stage were 115.00pg/ml,96.80pg/ml,and 294.50pg/ml,there was difference between the groups,(P<0.01).There were differences between CKD5 and CKD3,CKD4.,(P=0.001,<0.001,separately),between CKD3 and CKD4,no difference was found.(4)Patients with CKD have different degrees of hypoproteinemia,and albumin in patients with left ventricular hypertrophy is lower than that in patients with non-left ventricular hypertrophy.no difference was found,(P>0.05).Triglycerides,total cholesterol and low-density lipoprotein were basically in the normal range in all patients.The high-sensitivity C-reactive protein in patients with left ventricular hypertrophy was higher than that in patients with non-left ventricular hypertrophy,with the decline of renal function,there is an increase in hypersensitive C-reactive protein.(P<0.05),comparing statistical differences between groups,(P=0.001),the pairwise comparison,CKD3 and CKD4,CKD5 stage statistically significant,(P<0.001,0.005,separately),CKD4 and CKD5 stage no difference was found,(P>0.05).However,the white blood cell count was normal in all stages,no difference was found,(P>0.05).Among the patients with cardiac hyper-index,the left ventricular mass index is mainly changed.With renal dysfunction,LVMI is gradually increased.Association analysis showed that LVH was positively correlated with SBP,Scr,ALP,PTH,HSCRP,and LVMI.(r=0.385,0.309,0.461,0.157,0.315,0.832),while showed negatively related with HGB and EF%,(r=-1.71,-0.270),There was not associated with gender,antihypertensive drugs,BMI,Ca,P,ALT,AST,UA,WBC and ALB.Multivariate logistic regression analysis showed that SBP,Scr,ALP and HSCRP were independent risk factors for left ventricular hypertrophy.(5)Among 313 patients with chronic kidney disease,the incidence of vascular calcification in patients with ALP>84.80U/L was higher than that in patients with ALP?84.80U/L.The incidence of vascular calcification in patients with ALP was 69(22.0%)and 35(11.2%),separately,(P=0.001).The incidence of left ventricular hypertrophy was also significantly higher than that of ALP?84.80U/L patients,with 98(31.3%)and 19(6.1%)of left ventricular hypertrophy,respectively,(P<0.001).In all stages of CKD patients,the incidence of vascular calcification in patients with ALP>84.80U/L was higher than that in patients with ALP?84.80U/L,and there was statistical difference in CKD3 and CKD5 stages,but no statistical difference in CKD4 stage,P>0.05.Among patients with CKD at all stages,the incidence of left ventricular hypertrophy in patients with ALP>84.80U/L was higher than that of patients with ALP?84.80U/L,with statistical significance(P<0.05).In all stages of ALP>84.80u/L,HSCRP was higher than ALP<84.80u/L,and there was statistical difference in CKD3 and CKD4,but no no difference was found in CKD5.Among patients with ALP>84.80U/L,LVMI was higher than that of patients with ALP?84.80U/L at all stages,with statistical difference at all stages.Association analysis showed that ALP was positively correlated with vascular calcification,LVH,HSCRP,PTH and LVMI,(r=0.184,0.471,0.250,0.136 and 0.384),while showed negatively related with HGB and eGFR,(r=-0.135,-0.202).There was no correlation with WBC,NLR,ALT,AST,EF%.Multivariate logistic regression showed that vascular calcification and LVH were independent risk factors for ALP.(6)ROC curve analysis illustrated that the AUC(areas under the ROC curve),taking ALP and PTH as indicators,was 0.775 and 0.594,separately(95%CI:0.724-0.825,P=0.000;0.529-0.658,P=0.006,separately),When we designate the cutoff point of ALP value as 79.85U/L,the sensitivity(75.9%)and the specificity(33.2%)were highest in predicting left ventricular hypertrophy in patients with chronic kidney disease,When we designate the cutoff point of PTH value as 167.85pg/mL,the sensitivity(62.4%)and the specificity(44.9%)were highest in predicting left ventricular hypertrophy in patients with chronic kidney disease,suggesting that ALP was superior to PTH in the diagnosis of left ventricular hypertrophy.[Conclusion]1.Hypertension is mainly caused by an increase in volume load in patients with chronic kidney disease,and blood pressure is significantly increased with deterioration of renal function,and systolic blood pressure is significantly increased.2.Patients with chronic kidney disease with different degrees of anemia and hypoproteinemia,and their nutritional status tends to decline with the decline of renal function.3.The microinflammation state begins to appear in patients with early stage chronic kidney disease and is more severe in patients with left ventricular hypertrophy in each stage.4.With the decline of renal function,the incidence of left ventricular hypertrophy increases gradually in patients with stage 3-5 chronic kidney disease.5.Alkaline phosphatase plays a major role in the development of left ventricular hypertrophy in patients with chronic kidney disease.The abnormal calcium and phosphorus metabolism,elevated PTH,and ALP participate in the formation of left ventricular hypertrophy in the late stage.6.Alkaline phosphatase plays a role in the process of vascular calcification in patients with chronic kidney disease.7.Alkaline phosphatase can be used as a predictor of left ventricular hypertrophy in patients with chronic kidney disease.