Influencing Factors Analysis For Pulmonary Arterial Hypertension In CKD Stage 3-5 Non-dialysis Patients

Background:In recent years,the incidence and mortality of cardiovascular disease in patients with chronic kidney disease(CKD)have gradually increased,and dialysis patients have a higher risk of cardiovascular death.Pulmonary arterial hypertension(PAH)is another serious,progressive cardiovascular-related complications that has been common in patients with end-stage renal disease(ESRD)in recent years.Maintenance hemodialysis(MHD)patients with primary pulmonary hypertension are not uncommon and have a poor prognosis.Since the incidence of pulmonary arterial hypertension in patients with end-stage renal disease is relatively hidden,its main clinical manifestations are often concealed by the primary disease,which is difficult to find at an early stage,so it is easily overlooked clinically.At present,domestic and foreign scholars have paid more and more attention to the research of factors affecting CKD in patients with non-end-stage renal disease complicated with PAH.Prevention of pulmonary arterial hypertension may be a non-negligible goal to improve the prognosis of patients with CKD.In order to understand and master the influencing factors and pathogenesis of pulmonary arterial hypertension in CKD non-dialysis patients,this research retrospectively analyzed the occurrence of PAH and its influencing factors in the CKD stage 3-5 non-dialysis patients hospitalized in the First Hospital of Jilin University department of nephropathy from May 2017 to May 2018.To further explore its prevention and intervention measures,aim to improve the survival rate and quality of life of patients with CKD.Objective:To explore the incidence and related influencing factors of pulmonary hypertension in CKD stage 3-5 non-dialysis patients preliminarily.Methods:Retrospective analysis of the clinical data of 156 patients with CKD stage 3-5 non-dialysis inpatients who were admitted to the First Hospital of Jilin University May 2017 to May 2018.Divided into two groups according to the presence or absence of pulmonary arterial hypertension,the general data such as age,sex,height,weight,BMI,history of smoking and past medical history of the two groups were recorded.Collect Serum calcium,Serum phosphate,Calcium-phosphorus product(Ca×P),serum parathyroid hormone(PTH),Triglycerides(TG),High density lipoprotein cholesterol(HLD-C),Low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),hemoglobin(Hemoglobin,Hb),serum albumin(Albumin,Alb),alkaline phosphatase(Alkaline phosphatase,ALP)and other laboratory indicators and Left atrial diameter(LAD),right atrial diameter,ventricular septal thickness(IVST),left ventricular terminal diameter,left ventricular posterior wall thickness,aortic diameter,ejection fraction(EF)and other color doppler echocardiography results.Compare the above indicators of the two groups of patients,the above statistical data using SPSS 22.0 statistical software for analysis.Results:A total of 156 patients with CKD stage 3-5 non-dialysis were enrolled,97 males and 59 females,with an average of(53.46±14.44)years old.There were 30 patients in the PAH group and 126 patients in the non-PAH group,the incidence of pulmonary arterial hypertension is 19.2%,and the incidence of pulmonary arterial hypertension in CKD stage 5 non-dialysis patients is highest with 22.8%.The primary disease of 156 patients included: 79 cases of chronic glomerulonephritis(50.6%),23 cases of diabetic nephropathy(14.6%),9 cases of nephrotic syndrome(5.8%),31 cases(19.9%),15 cases of unknown cause(9.6 %).There were 127 cases(81.4%)with hypertension,56 cases(35.9%)with diabetes mellitus,13 cases(8.3%)with coronary heart disease,and 50 cases(32.1%)with the history of smoking among the 156 patients.There were no significant differences in gender composition,age,height,BMI,primary disease type,smoking history and other general data between PAH group and non-PAH group(P>0.05).There were no significant differences in laboratory indicators such as triglyceride,total cholesterol,serum creatinine,uric acid,alkaline phosphatase,high density lipoprotein cholesterol,low density lipoprotein cholesterol,blood calcium,calcium phosphate product,parathyroid hormone,C reaction protein and urine protein between PAH group and non-PAH group(P>0.05).There was no significant difference in right atrial diameter,left ventricular end-diastolic diameter,thickness of ventricular septum,aortic diameter,and posterior wall thickness of left ventricle between the two groups(P>0.05).Univariate analysis showed that the weight,hemoglobin,eGFR,and left ventricular ejection fraction of the PAH group were significantly lower than those of the non-PAH group.The urea nitrogen,blood phosphorus concentration,left atrial diameter,and coronary heart disease history in the PAH group were significantly higher than those in the non-PAH group,the difference between the two groups was statistically significant(P<0.05).Further logistic regression analysis showed that decreased serum albumin,low weight,decreased left ventricular ejection fraction and elevated urea nitrogen are independent influencing factors of PAH in CKD stage 3-5 non-dialysis patients.Decreased serum albumin,decreased ejection fraction are independent factors of PAH in CKD stage 5 non-dialysis patients(P<0.05).Conclusion:1.The incidence of pulmonary arterial hypertension in CKD stage 3-5 non-dialysis patients is higher with 19.2% in this study,and the incidence of pulmonary arterial hypertension in CKD stage 5 non-dialysis patients is highest with 22.8%.2.Body weight,hemoglobin,serum albumin,glomerular filtration rate,blood urea nitrogen,blood phosphorus concentration,left atrial diameter,ejection fraction may be associated with CKD3-5 non-dialysis patients with pulmonary arterial hypertension,and low serum albumin,low body weight,low ejection fraction and high blood urea nitrogen are its independent risk factors.