Study On The Correlation Between Monocyte/high-density Lipoprotein Ratio And Left Ventricular Hypertrophy And Renal Function Progression In Chronic Kidney Disease

BackgroundChronic kidney disease(CKD)has become one of the chronic diseases that affect human health and bring a heavy burden.CKD generally has no obvious symptoms in the early stage.If it is not detected and intervened in time,it will progress to end-stage kidney disease.Cardiovascular events are the most common complication and the main cause of death in patients with CKD;Left ventricular hypertrophy(LVH)is considered to be an independent predictor of cardiovascular death,and early recognition of the occurrence of LVH is very important for the prevention and treatment of cardiovascular events in CKD patients.The occurrence of atherosclerosis is the main cause of cardiovascular disease;in CKD patients,microinflammation,oxidative stress and lipid abnormalities play a role together in promoting the occurrence of atherosclerosis,leading to cardiovascular disease and accelerating the progression of kidney.Monocyte/high-density lipoprotein ratio(MHR)is a new marker of atherosclerosis discovered in recent years,which can reflect the state of inflammation and oxidative stress in the body,and is a risk factor of many cardiovascular and cerebrovascular adverse events.At present,no studies have linked MHR with LVH,and whether MHR is related to the progress of renal function in patients with CKD has not been reported.Our study retrospectively analyzed the clinical data of CKD patients,aiming to explore the relationship between MHR and left ventricular hypertrophy and renal function progression in CKD patients,in order to guide clinical diagnosis and treatment,delay the progression of CKD,and improve the survival rate of patients.Methods1.Part I:Study on the correlation between monocyte/high-density lipoprotein ratio and left ventricular hypertrophy in chronic kidney disease.Clinical data of CKD1-5 patients who were admitted to the Department of Nephrology of of Henan People’s Hospital from January 1,2017 to June 30,2020 were collected.CKD patients were divided into three groups according to glomerular filtration rate(GFR):A group,CKD1 stage(GFR≥90 ml/min/1.73m~2);B group,CKD2-3 stage(30ml/min/1.73m~2≤GFR<90ml/min/1.73m~2);C group,CKD4-5 stage(GFR<30ml/min/1.73m~2),and the baseline characteristics of the three groups were compared.CKD patients were divided into LVH group and non-LVH group according to LVH diagnostic criteria,and the difference of MHR level between the two groups was compared.According to the median baseline serum MHR(MHR=0.3193),CKD patients were divided into the low-level MHR group(MHR≤0.3193)and the high-level MHR group(MHR>0.3193),and the differences of cardiac ultrasound indexes between the two groups were compared.Spearman rank correlation analysis was used to analyze the correlation between MHR level and age,gender,hemoglobin(Hb),serum creatinine(Scr)and GFR in patients with CKD.Logistic regression analysis was used to screen the risk factors of LVH in patients with CKD,and stratified analysis explores the special population that affects MHR and LVH.2.Part II:Study on the correlation between monocyte/high-density lipoprotein ratio and renal function progression in chronic kidney disease.Clinical data of CKD1-5 patients who were admitted to the Department of Nephrology of of Henan People’s Hospital and followed up regularly from January 1,2017 to June 30,2020were retrospectively collected.The end-point event was defined as Scr doubled,GFR at least dropped 50%,entered into End-stage Renal Disease,started renal replacement therapy(hemodialysis,peritoneal dialysis or renal transplantation),died due to renal or cardiovascular events.Use December 31,2020 as the research deadline.According to the baseline serum MHR median(MHR=0.3478),CKD patients were divided into the low-level MHR group(MHR≤0.3478)and the high-level MHR group(MHR>0.3478),and the baseline characteristics of the two groups were compared.Kaplan-Meier analysis was used to draw the survival curve,and the difference of survival rate between the two groups was compared by Log-rank test.Cox proportional hazards models was used to analyze the risk factors of renal poor prognosis in CKD patients.Results1.Part I:Study on the correlation between monocyte/high density lipoprotein ratio and left ventricular hypertrophy in chronic kidney disease:(1)2199 cases were enrolled in this study,including 1476 males and 826 females.The average age was 48.01±15.88 years old.(2)The clinical data of CKD patients in the three groups showed that with the decrease of renal function,MHR,left ventricular mass index(LVMI)and the proportions of LVH increased gradually(P<0.05).(3)Compared with the non-LVH group,the LVH group had higher MHR levels.Compared with the low-level MHR group,left ventricular end diastolic dimension(LVEDD),left ventricular posterior wall thickness(LVPWT),interventricular septum thickness(IVST),LVMI,and proportion of LVH in the high-level MHR group were higher(P<0.05).(4)MHR and age,systolic blood pressure,body mass index(BMI),albumin(ALB),Scr,serum uric acid(SUA),blood urea nitrogen(BUN),calcium(Ca),phosphorus(P),LVEDD,LVPWT,IVST,LVMI were positively correlated.And MHR was negatively correlated with gender(female),Hb,24-hour urine protein,and GFR(P<0.05).(5)Taking LVH as the dependent variable,single factor logistic regression analysis showed that gender(female),age,history of hypertension,BMI,Hb,ALB,Scr,SUA,BUN,Ca,GFR,MHR may be the influencing factors of LVH.The above indicators were unified into the logistic regression model,and the results showed that gender(female),history of hypertension,decreased BMI,decreased Hb,decreased GFR,increased MHR(HR=2.894,95%CI=1.543-5.427,P=0.001)were independent risk factors for LVH(P<0.05).(6)The CKD population was stratified according to whether were complicated with hypertension and diabetes.The results suggested that MHR had a more significant impact on the occurrence of LVH in CKD patients when suffering from hypertension and diabetes(HR=3.092,95%CI=1.537-6.220,P for Interaction=0.000;HR=3.592,95%CI=1.116-11.566,P for interaction=0.019).2.Part II:Study on the correlation between monocyte/high density lipoprotein ratio and the progression of renal function in chronic kidney disease:(1)The study enrolled 405 cases,including 281 males and 124 females.The average age was 49.77±14.82 years old.Compared with the low-level MHR group,the high-level MHR group had more people in the late stage of CKD(P<0.05).(2)The median follow-up time was 8(4,16)months.To the end of the follow-up,113 patients(27.90%)had an end-point event.Kaplan-Meier survival curve analysis results showed that compared with the low-level MHR group,the high-level MHR group had a significantly lower renal cumulative survival rate(Log-rank X~2=8.277,P=0.004).(3)The results of univariate Cox regression analysis showed that hypertension,systolic blood pressure,Hb,Mono,HDL-C,Scr,SUA,BUN,Ca,P,GFR,MHR wre the influencing factors in the progression of CKD patients to the end-point event(P<0.05);Multivariate Cox proportional hazard model analysis results showed that elevated MHR level was an independent risk factor for poor renal prognosis in CKD patients(HR=4.687,95%CI=1.056-20.797,P=0.042).Conclusions1.Elevated MHR level may be an independent risk factor for LVH in CKD patients.2.Hypertension and diabetes can significantly enhance the role of MHR in the occurrence of LVH in CKD patients.3.MHR is negatively correlated with the renal cumulative survival rate;elevated MHR levels may be an independent risk factor for poor renal prognosis in CKD patients.