The Risk Factors Of Cardiovascular Disease In Patients With Chronic Kidney Disease And Its Current Research Of Treatment And Control

BackgroundThe prevalence of chronic kidney disease (CKD) is increasing worldwide and has become a global public health problem, especially in developed and developing countries. The progression of CKD ultimately leads to end-stage renal disease (ESRD) and its related complications. The medical costs are causing enormous economic burdens for the country, society and the families of patients. Patients with CKD are at very high-risk to develop cardiovascular disease (CVD) and the occurrence of cardiovascular disease. CVD the major complication and the leading cause of morbidity and mortality in CKD. The incidence of traditional risk factors for cardiovascular disease is older age, male gender, hypertension, diabetes, smoking, obesity, hyperlipidemia, family history and left ventricular hypertrophy (LVH). The nontraditional risk factors are hyperhomocysteinemia, calcium-phosphorus metabolism imbalance, secondary hyperparathyroidism, anemia, malnutrition, oxidative stress, and inflammation. The traditional and nontraditional risk factors of cardiovascular disease are related closely to the risk factors of progression of renal dysfunction. With the progress of CKD, it often involves multiple organ damage, and this damage turns to increase the degree of injury to the kidney and accelerate the rate of renal dysfunction. Thus, aggressive treatment and strict control of risk factors of CKD and CVD have contributed greatly to slow the rate of the progression of kidney dysfunction and morbidity of CVD in patients with CKD.ObjectiveTo investigate the related risk factors of cardiovascular disease in patients with chronic kidney disease and the progression of renal insufficiency, with aims to slow the progression of CKD and prevent the incidence of CVD in patients with CKD through understanding of the common risk factors for chronic kidney disease and cardiovascular disease.MethodsStudy Population:From January1,2008to December31,2008, patients were recruited from the Zhongshan Hospital of Fudan University, witha total of1020cases, with527males, and493females. There were314,242,188,177, and159cases of patients in stage1-5CKD, respectively. Demographic data (age, sex, race, smoking status, hypertension, diabetes), medical history and the results of laboratory tests were also collected.Statistical AnalysisAll statistical analyses were performed using SPSS17.0. Univariate statistics are reported as mean±SD or counted with proportion, as appropriate. We calculated χ2P for categorical variables and t-test P for continuous variables. We also use other methods, such as ANOVA and multiple regression. P value of less than0.05is considered statistically significant.Results1The basic characteristics of CKD:51.7%of the1020CKD patients were male and48.3%were female, with an average age of48.32±17.68. The percentage of CVD in1-5stage CKD was17.5%,25.2%,42.6%,52.1%and59.7%, respectively.2The basic characteristics of CVD in patients with CKD:The incidence of CVD in patients with CKD is34.5%. The incidence of CVD show an increasing trend with the progression of CKD. The incidence of coronary artery disease (CAD), congestive heart failure (CHF), cardiomyopathy, arrhythmia and left ventricular hypertrophy (LVH) is33.0%,8.6%,2.5%,15.8%and63.1%. respectively. The most prevalent pathological form of CVD was LVH. Among CVD patients, those with two different forms of CVD included59cases, accounting for21.1%; those with three different forms of CVD included5cases, accounting for1.8%. The percentage of CVD patients with myocardial infarction (MI) was2.2%, with coronary artery bypass grafting (CABG) accounting for1.1%, and with percutaneous coronary intervention (PCI) accounting for10.9%.3The risk factors of CVD and its control situation and treatment(1) Hypertension:The incidence of hypertension was73%, of which71.7%were male and74.3%were female. The incidence of hypertension in stage1-5CKD was60.6%,62.6%,81.7%,88.2%and89.4%, respectively. Its prevalence increases as glomerular filtration rate (GFR) declines. The rate of using antihypertensive drugs was95%.63.9%of CKD patients received calcium channel inhibitors and61%of patients received angiotensin I converting enzyme inhibitor or angiotensin-receptor blocker.30.2%of patients used one type of drug,39.4%used two types of drugs, and24.7%of patients used three or more types of drugs. Blood pressure was controlled at a level below140/90mmHg in57.8%of patients, and below130/80mmHg in14.1%of patients. Among hypertensive patients, those with24-hour urinary protein≥1g were found in376cases, accounting for60.2%, but the percentage of patients who controlled blood pressure below125/75mmHg was only8.7%.(2) Hyperuricemia:The incidence of hypertension was73%, of which71.8%were male and23.6%were female. The prevalence of hyperuricemia was increased among all age groups (P<0.05). The incidence of hyperuricemia in stage1-5CKD were24.3%,36.1%,61.7%,71.8%and81.2%, respectively. The research showed that only23.2%of inpatient hyperuricemic patients knew they were suffering from hyperuricemia, and had received treatment. The total compliance rate of receiving medical treatment was20.8%and the compliance rate in the five stages (1-5) of CKD patients were50.7%,21.7%,12.3%,13.4%and16%, respectively. There were significant differences in the incidence of CVD between the treatment compliant group and the treatment non-compliant groups (P<0.01).(3) Metabolic Syndrome (MS):The incidence of MS was30.7%. Among patients with MS, the incidence of obesity (BMI>25kg/m2), hypertriglyceridemia, low HDL hyperlipidemia, diabetes and hypertension were31.1%,44.3%,24.6%,13%, and73%respectively. MS patients have metabolic syndromes comprising one component, two components, three components, four components and five components were26.6%,32.7%,19.7%,9.5%,1.5%, and30.7%, respectively. Only10%of patients with CKD do not have MS components and the majority of proportions in CKD with MS were1-2MS components. This study showed that diabetic patients accounted for13%and the number of MS components in diabetic patients was significantly increased. Diabetic patients with MS accounted for71.2%and non-diabetic patients accounted for25%. Among the components of MS, the highest proportion was hypertension, followed by hyperlipidemia, and the lowest was impaired glucose intolerance. Analyses showed that metabolic syndrome was related to the incidence of CVD from the results of correlation analysis (P<0.01) and the higher risk with the higher number of MS components.(4) Hyperlipidemia:The incidence of hyperlipidemia was69.3%, of which53.7%were taking statin treatment.54.6%were male and45.4%were female. (P<O.05). The proportion with hypertriglyceridemia was62.9%, those with hypercholesterolemia was53.7%, those with high LDL hyperlipidemia was33.7%, and those with low HDL hyperlipidemia was35.5%. The incidence of stage1-5CKD was64.7%,30.3%,26.9%,28.1%, and24.4%, respectively. The prevalence of hyperlipidemia among those with CKD stages1-5were64.7%,30.3%,26.9%,28.1%,24.4%, respectively, of which CKD1and4and at CKD stages4and5were statistically significant (P<0.05). According to risk factor stratification, extremely high risk group accounted for24.9%, high risk group accounted for35.2%and moderate high risk group accounted for35.2%. After treatment, the compliance rates of moderate risk group, high risk group, and extremely high risk group were86.6%,45.9%and30.8%, respectively. With increased of risk factor stratification, the compliance rate was decreasing (P<0.05). This study shows that women’s compliance rate lower than that of men.(5) Anemia:The incidence of anemia was45.2%, of which71.7%were male and74.3%were female. According to the degree of anemia, the percentage of mild anemia, moderate anemia and severe anemia accounted for32.5%,11.1%, and1.7%, respectively. The incidence of hypertension in stage1-5CKD was19.7%,24.8%,50.5%,78.6%, and95.6%, respectively. Its prevalence increases as glomerular filtration rate (GFR) declines and the level of hemoglobin was decreases(P<0.01). The total compliance rate was33%by the standard of hemoglobin≥110g/L, and the compliance rates in stage1-5CKD were52.5%,35%,42.3%,31.3%, and17.4%respectively. Multivariate analysis showed that women, age (≥65years old), diabetes, hypertension and hyperuricemia were independent risk factors for anemia in patients with CKD. The incidence of CVD in CKD patients with anemia was44.3%, significantly higher than the incidence of26.5%in those without anemia.(6) Calcium-Phosphate metabolism and parathyroid hormone (PTH):This study shows that the incidence of secondary hyperparathyroidism (SHPT) was23.7%, and the rates of incidence in stage3-5CKD were21.3%,50%and82.1%respectively. The level of PTH was significantly higher in stage3-5CKD. According to K/DOQI guidelines, the percentages of hypocalcemia in stage3-5CKD was3.3%,6.3%, and25.5%, respectively, and the percentages of hyperphosphatemia were4.3%,17.9%, and30.5%, respectively. The compliance of receiving vitamin D in stages3-5CKD were13.3%,35.9%and25.8%, respectively, and the proportion of taking Calcitriol was5.9%,2.6%, and1.3%. After treatment, the level of PTH reached normal levels; iPTH levels in patients with stage3-5CKD were14.7%,23.1%, and20%, respectively.(7) Homocysteine (Hcy), high sensitive C-protein (hsCRP), and beta2-microglobulin (β2-MG):Hey, hsCRP, and β2-MG were negatively correlated with GFR (γ was-0.37,-0.25and-0.87). CVD group and non-CVD group showed that the β2-MG was significantly different (P<0.01), but hsCRP and Hey had no significant differences (P>0.05).(8) Smoking:In this study,137cases out of1020cases of patients were smokers, all male, accounting for13.4%. Stage1-5CKD was12%,13.5%,21.7%,19.6%, and16.3%, respectively. The analysis showed that smoking was significantly closed to GFR and the incidence of CVD.59patients choose to stop smoking, accounting for43.7%.4. The analysis of risk factors related to CVD:Multiple stepwise regression analysis show that eGFR (OR0.99, P<0.01) was negatively correlated with the incidence of CVD. Age, hypertension, diabetes, and hyperuricemia (OR1.04. P<0.01; OR1.53, P<0.05; OR2.73, P<0.01;OR1.70, P<0.01) showed positive correlations to the incidence of CVD.ConclusionCardiovascular disease (CVD) is the major complication in patients with chronic kidney disease (CKD), with the highest prevalence of pathological CVD being left ventricular hypertrophy (LVH) and coronary heart disease (CAD). CKD has unacceptably high risk factors for CVD, and does not show satisfactory results for control and treatment of CVD. The rate of control and treatment in CKD patients with hypertension, hyperuricemia, and hyperlipidemia was lower. More focus should be placed on the control and treatment of risk factors of CVD in patients with chronic kidney disease.