| Objective: Diabetic kidney disease is a common type of kidney disease,accounting for the vast majority of the end-stage renal disease in many developed countries.However,in our country,the incidence of diabetic kidney disease is also increasing year by year,and as a result,has become the first cause of chronic kidney disease.As we all know,with the progress of the disease,patients with chronic kidney disease,including diabetic kidney disease,often accompanied by a variety of complications,of which cardiovascular disease is the most important one,which seriously affect the survival rates and brought great inconvenience to these patients.It is reported that left ventricular hypertrophy is an important predictor of cardiovascular disease in populations that suffered from CKD,and its main evaluation index is left ventricular mass index.Studies have shown that there is a negative correlation between serum bilirubin and the risk of cardiovascular disease.Hence,the purpose of our study was to analyze the relationship between serum bilirubin and left ventricular hypertrophy in patients with CKD from stage1 to stage3,causing by diabetic kidney disease,and to explore other potential related factors of left ventricular hypertrophy,so as to provide some help for disease surveillance and prevention in this population.Methods: A total of 261 patients who were hospitalized in the First Affiliated Hospital of Dalian Medical University from January 2018 to August 2020,diagnosed as chronic kidney disease with stage 1 to stage 3,and suffering from diabetic kidney disease,were selected.The basic information of the patients such as past medical history and other ordinary informations as well as laboratory data and echocardiographic data were gathered.The levels of bilirubin and the incidence of left ventricular hypertrophy in distinct stages of CKD were compared by Chi-square analysis as well as ANOVA.Spearman rank correlation analysis was used to explore the correlation between bilirubin and clinical indexes of the patients.All patients were divided into two groups: LVH group(104 cases)and non-LVH group(157 cases).T-test,nonparametric test and Chisquare test were employed by us to compare the disparity of clinical date between the above groups.In the same time,we applied binary logistic regression to explore the independent ralated factors of LVH in diabetic kidney disease population.Results:1.The levels of serum total bilirubin,LVMI and the incidence of LVH in patients with diabetic kidney disease: we found that with the increase of chronic kidney disease stage,the level of serum total bilirubin decreased gradually,while the level of LVMI increased gradually.In addition,the incidence of left ventricular hypertrophy was significantly various in patients with different stages of chronic kidney disease,manifested as CKD stage1 < CKD stage2 < CKD stage3(p < 0.05).2.Correlation between bilirubin and main clinical indicators: Spearman correlation analysis showed that serum total bilirubin was positively correlated with estimated glomerular filtration rate,hemoglobin,albumin and serum calcium,but negatively correlated with LVMI,24 hours urinary protein quantitation,total cholesterol and low density lipoprotein cholesterol,lipoprotein(a)(p < 0.05).3.Comparison of clinical data between the LVH group and non-LVH group: we noticed that compared with non-LVH group,the proportion of female,the proportion of patients with diabetes for more than 10 years as well as patients with hypertension,the levels of 24 hours urinary protein quantitation,LDL-C,TC and serum phosphorus in LVH group were higher,while the levels of eGFR,albumin,serum total bilirubin,hemoglobin,as well as were serum calcium were lower.However,we did not found significant difference in age,body mass index,blood glucose,uric acid,high density lipoprotein cholesterol,triglyceride and Lp(a)between the two groups..4.Analysis of independent related factors of left ventricular hypertrophy in patients with CKD from stage 1 to stage 3: through analysis,we found that female,lower eGFR,lower serum total bilirubin,hypertension and anemia were independent related factors for left ventricular hypertrophy(p < 0.05).In other words,The risk of developing left ventricular hypertrophy in female patients was 5.358 times higher than that in male patients(p=0.000,OR=5.358,95%CI 2.465-11.645).And,compared with CKD satge 1,the risk of left ventricular hypertrophy in patients with CKD stage2 was 5.023 times higher than that in CKD stage 1(p=0.001,OR=5.023,95%CI 1.931-13.065),and the risk of left ventricular hypertrophy in patients with CKD stage 3 was 6.285 times higher than that in CKD stage 1(p=0.000,OR=6.285,95%CI 2.240-17.629).However,The risk of left ventricular hypertrophy in patients with serum total bilirubin < 8.5 umol/L was3.159 times higher than that in patients with serum total bilirubin ≥8.5 umol/L(p=0.002,OR=3.159,95%CI 1.516-6.583).The risk of left ventricular hypertrophy in patients with hypertension was 2.352 times higher than that in patients without hypertension(p= 0.048,OR=2.352,95% CI 1.006-5.497).In addition,we found that anemic patients had a higher risk of LVH,which was 3.831 times higher than that of non-anemic patients(p=0.000,OR=3.831,95%CI 1.800-8.156).Couclusions:1.With the increase of CKD stage,the level of serum total bilirubin decreased gradually.2.In patients with CKD from stage 1 to 3,serum total bilirubin is an independent risk factor for LVH.3.eGFR,anemia,hypertension and gender were also independently related to the occurrence of LVH in patients with DKD. |
