Abnormalities Of Cardiac Structure And Function In Patients With Chronic Kidney Disease

Objective:This study was designed to analyze the abnormal changes of cardiac structure and function in patients with chronic kidney disease(CKD),and to explore the clinical factors affecting left ventricular hypertrophy(LVH)and left ventricular diastolic dysfunction(LVDD)in patients with CKD,in order to provide evidence for improving cardiovascular prognosis in patients with CKD.Methods:This retrospective study analyzed CKD patients hospitalized in the department of nephrology at the First Affiliated Hospital of Soochow University from March 2016 to August 2018.The general conditions of gender,age,height,weight,blood pressure,primary disease,hypertension and diabetes mellitus,as well as laboratory indexes such as hemoglobin(Hb),red blood cell distribution width(RDW)and serum creatinine(Scr)were collected.Body mass index(BMI)and glomerular filtration rate(eGFR)were calculated.All patients were examined by echocardiography.We recorded and evaluated the echocardiographic parameters,cardiac lesions such as LVH,Left ventricular remodeling,LVDD,left ventricular systolic dysfunction and valvular diseases.Statistical analysis was performed using the SPSS 24.0.We analyzed and compared the general conditions,echocardiographic parameters and cardiac abnormalities of patients with different CKD stages.Logistic regression analysis was used to analyze the risk factors for LVH and LVDD.A receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of RDW in CKD patients with LVDD.Outcome:1.The prevalence of LVH was 50.00%in a total of 404 patients with CKD,and 16.07%,33.33%,41.18%,57.50%and 71.97%respectively in each stage of CKD.Eccentric hypertrophy was found in 7.14%,23.53%,31.76%,48.75%and 53.79%respectively of patients with CKD at stages 1-5.With the progression of CKD,the prevalence of left ventricular normal geometry decreased,while the prevalence of eccentric hypertrophy increased gradually.2.Left ventricular diastolic dysfunction(LVDD)occurred in 149 cases(36.88%).The prevalence of LVDD in patients with stage 1-5 CKD was 12.50%,29.41%,31.76%,37.50%and 53.03%,respectively.The prevalence of LVDD in the five groups increased gradually with the progression of CKD.The patients with CKD at stages 1-3 were mainly LVDD grade ?,and the prevalence of LVDD grade ? was significantly higher in patients with CKD at stages 4-5.3.There were fewer left ventricular systolic dysfunction in patients with CKD in this study(6/404 cases).The main cardiac valvular diseases were mitral regurgitation(14.85%)and aortic valve regurgitation(13.12%).The prevalence of them increased gradually with the progression of CKD.In addition,pericardial effusion was mainly found in patients with stage 5 CKD(18.94%).4.By multivariate logistic analysis,gender(female,OR=2.43,95%CI:1.483-3.98,P<0.001),systolic blood pressure(OR=1.038,95%CI:1.022-1.056,P<0.001),Hb(OR=0.981,95%CI:0.97-0.993,P=0.002)and eGFR(OR=0.987,95%CI:0.978-0.996,P=0.005)are independently associated with LVH in patients with CKD.5.By multivariate logistic analysis,age(OR=1.036,95%CI:1.018-1.055,P0.001),diabetes mellitus(OR=1.797,95%CI:1.021-3.163,P=0.042)and systolic blood pressure(OR=1.039,95%CI:1.021-1.057,P<0.001),BMI(OR=1.111,95%CI:1.039-1.188,P=0.002),RDW(OR=1.836,95%CI:1.349-2.498,P<0.001),Scr(OR=1.002,95%CI:1.001-1.003,P<0.001)are independently associated with LVDD in patients with CKD.The area under the ROC curve of RDW level for the detection of LVDD in patients with CKD was 0.669,95%CI:0.614-0.725,P<0.001.The optimal cut-off value in the ROC analysis for RDW was ?13.15%.This value was characterized by the sensitivity of 57.70%and specificity of 69.00%for diagnosing LVDD.Conclusion:1.Patients with CKD have abnormal changes of cardiac structure and function even in the early stages,gradually aggravating with the progression of renal failure.2.Left ventricular hypertrophy is the most important cardiac structural change in patients with CKD.The alternations of left ventricular geometry are different in each stage of CKD.Eccentric hypertrophy is the main left ventricular remodeling in patients with CKD at stages 4-5.The most important abnormality of cardiac function i5 left ventricular diastolic dysfunction.The main cardiac valvular diseases are mitral regurgitation and aortic valve regurgitation.3.Female,high systolic blood pressure,low Hb and low eGFR are independent risk factors for LVH in patients with CKD.4.Higher age,diabetes mellitus and the increase of systolic blood pressure,BMI,RDW and Scr are independent risk factors for LVDD in patients with CKD.The value of RDW to predict LVDD in patients with CKD is limited.