Clinical Study On Serum 25-hydroxy-vitamin D₃ And Left Ventricular Hypertrophy In Patients With Chronic Kidney Disease From Stage 1 To 3

Objective:Cardiovascular Disease is the leading cause of death in patients with chronic kidney disease.Left ventricular hypertrophy is a common cardiovascular disease in patients with chronic kidney disease and often predicts poor outcomes.Deficiency of serum 25-hydroxyvitamin D₃ is common in patients with chronic kidney disease.Many experiments have shown vitamin D receptor are expressed in cardiomyocytes,endothelial cells and fibroblasts.Vitamin D deficiency may be one of the risk factors for an increased risk of death from cardiovascul-ar disease.Serum 25-hydroxyvitamin D₃ is widely used in the world to indicate vitamin D levels in human body.This study was designed to observe 25-hydrox-yvitamin D₃deficiency and left ventricular hypertrophy in patients with chronic kidney disease,and investigate the relationship between serum 25?OH?D₃and LVH in patients with chronic kidney disease stage 1-3 and the risk factors of LVH.Methods:1.This study is a cross-sectional study.195 patients with chronic kidney disease from the Department of Nephrology of the First Affiliated Hospital of Dalian Medical University from January 2016 to November 2019 were selected through the electronic medical record system.2.Patients'demographic information,past medical history,history of the primary disease,height,weight,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,trigl-yceride,24-hour proteinuria,albumin,creatinine,hemoglobin,25?OH?D_3,parathyroid hormone,calcium,phosphorus were recorded and body mass index,glomerular filtration rate,adjust calcium were calculated according to the formula.Color doppler ultrasound was used to measure the left ventricular end-diastolic diameter,ventricular septal end-diastolic thickness,left ventricular posterior wall end-diastolic thickness,and the left ventricular mass index was calculated according to the formula.3.Patients were divided into two groups according to the K/DIGO guidelines:chronic kidney disease from stage 1 to 3?136 cases?and chronic kidney disease from stage 4 to 5?59 cases?.According to the K/DIGO guidelines,25?OH?D₃ deficiency was defined as 25?OH?D₃ less than or equal to 15ng/m L.Chi-square test and rank-sum test were used to compare the levels of 25?OH?D₃,LVMI and LVH in different stages of chronic kidney disease.4.Patients?136 cases?with chronic kidney disease from stage 1 to 3 were selected.According to the recommendation of the American society of echocardiography,LVMI greater than 88g/m²?for female?and 102g/m²?for male?obtained by two-dimensional echocardiography were diagnosed as LVH.Patients were divided into LVH group?37cases?and non-LVH group?99cases?.Independent sample t test,chisquare test,and rank sum test were used to compare the differences in baseline data of patients with chronic kidney disease from stage 1 to 3 with different LVMI levels.Furthermore,binary logistic regression was used to analyze the risk factors for left ventricular hypertrophy in patients with chronic kidney disease from stage 1 to 3.Rsults:1.The levels of 25?OH?D₃,LVMI and LVH were compared in different stages of chronic kidney disease.Compared with patients with chronic kidney disease from stage1 to 3,the levels of LVMI?P=0.045??the incidence of left ventricular hypertrophy?X²=6.427,P=0.011?and 25?OH?D₃ deficiency?X²=4.033,P=0.045?in patients with chronic kidney disease from stage 4 to 5 were significantly increased.The difference was statistically significant.2.The differences in clinical baseline data among patients with chronic kidney disease from stage 1 to 3 at different levels of left ventricular mass fraction were compared:Compared with the non-LVH group,age,total cholesterol,low-density lipoprotein cholesterol,24-hour proteinuria,phosphorus,parathyroid hormone,prevalence of hypertension,proportion of women,prevalence of diabetes,incidence of 25?OH?D₃ deficiency were all increased in LVH group and GFR,albumin,hemoglobin were all decreased.The difference was statistically significant.However,BMI,triglyceride,high-density lipoprotein cholesterol and adjusted calcium showed no significant difference.3.Independent risk factors for left ventricular hypertrophy in patients with chronic kidney disease from stage 1 to 3 were analyzed:women,decreased glomerular filtration rate,decreased albumin,increased parathyroid hormone and 25?OH?D₃ deficiency were independent risk factors for left ventricular hypertrophy?P<0.05?.The risk of LVH in women was 5.528 times higher than that in men?P=0.014,OR=5.528,95%CI=1.411-21.655?.The risk of LVH in patients with chronic kidney disease stage 3 was 17.911 times higher than that in patients with chronic kidney disease stage 1?P=0.006,OR=17.911,95%CI=2.334-137.470?.The risk of LVH in patients with albumin<30g/L was 7.048 times higher than that in patients with albumin?30g/L?P=0.019,OR=7.048,95%CL=1.386-35.850?.The risk of LVH in patients with parathyroid hormone?65pg/ml was 7.638 times higher than that in patients with parathyroid hormone<65pg/ml?P=0.021,OR=7.638,95%CI=1.360-42.895?.The risk of LVH in patients with 25?OH?D₃?15ng/m L was 4.896times higher than that in patients with 25?OH?D₃>15ng/m L?P=0.039,OR=4.896,95%CI=1.081-22.179?.Conclusions:1.With the progression of chronic kidney disease,the levels of LVMI,the incidence of left ventricular hypertrophy and 25?OH?D₃deficiency increases gradually;2.25?OH?D₃ deficiency,women,decreased glomerular filtration rate,decreased albumin,and increased parathyroid hormone were independent risk factors for left ventricular hypertrophy in patients with chronic kidney disease from stage 1 to 3.