A Study On The Risk Factors Of Cardiovascular And Cerebrovascular Accident In Patients With Maintenance Hemodialysis

Background:Chronic renal failure(CKD)is a kind of clinical syndrome caused by metabolic disorder and renal secretion dysfunction caused by various primary or secondary renal diseases.With the progression of the disease,the patients present with renal dysfunction,and finally the progression of end-stage renal disease(ESRD)leading to various cardiovascular and cerebrovascular diseases.Maintenance hemodialysis(MHD)is an effective method to treat ESRD,but some patients still die from cardiovascular and cerebrovascular complications,resulting in high mortality.Therefore,it is particularly important to explore the risk factors of cardiovascular and cerebrovascular diseases in MHD patients for the prevention and treatment of clinical ESRD.Objective:To explore the risk factors of cardiovascular and cerebrovascular diseases in MHD patients,so as to provide reference for the clinical treatment of these diseases.Methods:285 cases of ESRD patients receiving MHD in the blood purification center of People's Hospital of Yixing from May 2013 to March 2018 were selected as study objects,according to whether or not the occurrence of cardiovascular and cerebrovascular accidents,they were divided into the occurrence group(n=137)and the non-occurrence group(n=148).Basic clinical data of patients were collected,including gender,age,blood pressure,etiology,educational level,frequency and mode of dialysis,family income,age of dialysis,complications and other information.And the differences in the general demographic characteristics(including gender,age,blood pressure,cultural level,family income,age of dialysis,etc.),primary diseases(mainly include chronic glomerulonephritis(CGN),high blood pressure,kidney disease(HTN),diabetic nephropathy(DN),polycystic kidney(PKD)),cardiovascular events(including congestive heart failure,ischemic heart disease,malignant arrhythmia,cerebrovascular accident,peripheral vascular disease,etc.),laboratory indexes(including blood biochemistry,blood routine,serum creatinine(Scr),blood urea nitrogen(BUN)and phosphorus,blood calcium,hypersensitive c-reactive protein(hs-CRP,TG,high-density lipoprotein cholesterol(hdl-c),low-density lipoprotein cholesterol(ld1-c),full-segment parathyroid hornone(iPTH)levels,etc.)of the two groups were analyzed,and analyzed the single factor related to the above factors,and then analyzed the risk factors of cardiovascular and cerebrovascular accidents in MHD patients.Results:1 In this study,a total of 300 patients with enderwent MHD were included,besides the 15 patients who lost the interview,the medical records of 285 patients were included.All the patients received MHD,among them,137 cases were involved in cardiovascular and cerebrovascular accidents,,the incidence was 48.07%,148 cases were not involved in cardiovascular and cerebrovascular accidents.2 The primary diseases of 285 MHD patients were mainly 133 cases of CGN(46.67%),56 cases of HTN(19.65%),78 cases of DN(19.37%),3 cases of PKD(1.05%),6 cases of interstitial nephritis(2.11%),7 cases of obstructive nephritis(2.46%),and 2 case of lupus nephritis(0.70%).In the occurrence group,there were 39 cases of CGN(28.47%),39 cases of HTN(28.47%),37 cases of DN(38.69%),3 cases of PKD(2.19%)and 3 cases of interstitial nephritis(2.19%).In the non-occurrence group,there were 94 cases of CGN(63.51%),17cases of HTN(11.48%),25 cases of DN(16.89%),3 cases of interstitial nephritis(2.03%),7 cases of obstructive nephropathy(4.73%),and 2 case of lupus nephritis(1.35%).The occurrence group was dominated by DN,while the non-occurrence group was dominated by CGN,the differences between the two groups of HTN and DN were statistically significant(P<0.05).3 137 cases of patients in the occurrence group,the composition of cardiovascular and cerebrovascular accident events was:27 cases(19.71%)complicated with congestive heart failure,45 cases(32.85%)of ischemic heart disease,5 cases(3.65%)of malignant arrhythmia,37 cases(27.01%)of cerebrovascular accident,and 23 cases(15.65%)of peripheral vaseular disease.4 Through comparing the basic information of the MHD patients in the two groups,it can be seen that the two groups have significant differences in age,systolic blood pressure,dialysis age and atherosclerosis(P<0.05),while the two groups have no significant differences in gender,diastolic blood pressure,educational level,family income,medical insurance and employment(P>0.05).5 Through comparing the laboratory indexes of the ESRD patients receiving MHD in the two groups,it showed that the two groups have significant differences in Scr,blood phosphorus,hs-crp and TG(P<0.05),while the two groups have no signifieant differences in Hb,ALB,BUN,blood calcium,HDL-C,LDL-C and iPTH(P>O.05).6 The results of multi-factor analysis of cardiovascular and cerebrovascular accidents affeecting ESRD showed that:age?50(B=0.423,P=0.031,95%CI=1.058-3.056),longer dialysis age(B=0.849,P=0.013,95%CI=1.227-3.792),atherosclcrosis(B=0.584,P=0.038,95%CI=1.129-4.021),hypertension(B=0.231,P=.027,95%CI=1.342-9.247),DN(B=0.359,P=0.041,95%CI=1.187-8.271),abnormal elevation of hs-CRP(B=0.832,P=0.004,95%CI=1.116-3.894),high serium inorganic phosphorus(B=0.910,P=0.007,95%CI=1.538-10563),abnormal elevation of TG(B=0.497,P=0.012,95%CI=1.079-5.572)are the independent influencing factor of cardiovascular and cerebrovascular accidents.Conclusion:Most MHD patients have various cardiovascular and cerebrovascular diseases,among which the age?50,longer dialysis age,atherosclerosis,hypertension,DN,abnormal elevation of hs-CRP,high serium inorganic phosphorus and abnormal elevation of TG are the independent factors leading to the occurrence of cardiovascular and cerebrovascular accidents in MHD patients.