Risk Factors Of Renal Anemia And The Effect Of Anemia On The Heart In Elderly Patients With CKD

Background:Anemia is a common complication in elderly patients with Chronic kidney disease (CKD). Anemia can deteriorate the renal function and reduce the patient’s life quality. At the same time, anemia is the independent risk factor on cardiovascular disease. The causes of anemia include:the lack of erythropoietin (EPO), the lack of hematopoietic raw materials (such as:iron, folic acid, vitamin B12, etc.), uremic toxins, microinflammatory state,hyperparathyroidism, aluminum poisoning, hypoproteinemia, hemolysis and bleeding, etc. Various factors interact on each other to speed up the progression of the disease, and lead to the occurrence of various complications through the same or different mechanisms. Therefore, it is helpful to improve the patient’s quality of life, reduce the rate of complications and descend the case fatality rate by making clear of the renal anemia’s risk factors, strengthening the prevention and treatment of anemia.Objective:To investigate the risk factors of renal anemia and the effect on the heart in elderly patients with CKD.Methods:The clinical datas of 344 patients (age≥ 65 years) in nephropathy Division of our hosipital from January 2014 to Nowember 2015 were collected and retrospectively analyzed. The patients were divided into CKD2,3,4,5 according to the Glomerular Filtration Rate (GFR) levels, then the clinical datas were analysised. Meanwhile we divided the 344 paitients into two groups, according to the Hemoglobin (HGB) levels,one was a group with anemia, and the other group without anemia, then we compared the laboratory indexes and the results of echocardiogram between the two groups. We used the SPSS 19.0 statistical software to analyze the datas. Normal or near normal distribution of measurements were described as ((?)+s).We used analysis of variance to compare the indexes, and used LSD to anlyze the multiple comparison. If the indexes were not consistent with the normal distribution or approximate normal distribution, we used the Kruskal-Wallis test to analysis the datas. The count conducted chi-square test. Each data was used linear correlation analysis (Pearson related and Spearman correlation analysis) to analyze. The factors that may be relevant to anemia were analyzed by using logistic regression. The factors that may be relevant to GFR were analyzed by using multiple linear regression analysis.2-tailed P value less than 0.05 was considered statistically significant.Result:1. General information:(1) the primary disease:primary disease was chronic glomerulonephritis, a total of 89 cases (25.9%), followed by hypertensive nephropathy in 68 cases (19.8%), diabetic nephropathy in 64 cases (18.6%). (2) anemia:44 patients of the 344 cases were normal hemoglobin (HGB), accounting for 12.8%; 152 cases were mild anemia, accounting for 44.2%; 134 cases were moderate anemia, accounting for 39%; 14 cases were severe anemia, accounting for 4.1%. The major type of anemia were mild anemia and moderate anemia in the elderly patients with CKD. In the 344 patients, the percentage of CKD patients in 2-5 stage CKD was 3.7%(11 cases),14.7%(44 cases),26.3%(79 cases),55.3%(166 cases). As renal function deteriorating, the prevalence of anemia was increased (P< 0.01).2. Laboratory Indexes:There were significantly significant differences among four groups in blood urea nitrogen (BUN), blood creatinine (Scr), Kalium(K), Carbon Dioxide Combining Power(CO2CP), parathyroid hormone (PTH), blood lymphocyte(LY), hemoglobin (HGB), triglyceride (TG), and free triiodothyronine (P< 0.01). There were statistical differences among the 4 groups in retinol binding protein(RBP), sodium(Na), calcium(Ca) and total cholesterol(TC) (P< 0.05). There were no statistical significance in uric acid (UA), Cystatin C (Cys C), serum chlorine, phosphorus (P), white blood cell, red blood cell, platelet, blood albumin (ALB) and C reactive protein of (CRP), thyroid stimulating hormone and FT4 (P> 0.05).3. Correlation:(1) GFR increased with the level of Scr,BUN,PTH were significantly negative correlation (P< 0.01). GFR increased with the level of serum progesterone was negative correlation (P< 0.05). GFR increased with the level of HGB was significantly positive correlation (P< 0.01). GFR increased with the level of serum calcium, calcium phosphorus product, red blood cells were no correlation (P> 0.05). (2) HGB increased with the level of Scr, BUN, PTH, E peak, A peak were significantly negative correlation (P< 0.01). HGB increased with the level of left ventricular diastolic diameter was negative correlation (P< 0.05). HGB increased with the level of GFR, CO2CP, Alb, aortic root dimension were significantly positive correlation (P< 0.01). HGB increased with the level of serum Ca, P, CRP, ferritin, transferrin saturation were no correlation (P> 0.05). (3) Multiple linear regression analysis showed that the level of Scr, HGB were effect factors to GFR. Logistic regression analysis showed the level of proteinuria, PTH and CKD stage were the effect factors to anemia. (4) Left atrial enlargement, heart enlargement, left ventricular hypertrophy were significantly different between anemia group and non anemia group (P<0.05).Conclusion:1. Chronic glomerulonephritis was the main renal disease in elderly patients with CKD, followed by hypertensive nephropathy, diabetic nephropathy.2. Mild and moderate anemia were common in the elderly patients with CKD.3. The level of Scr, HGB were effect factors to GFR.4. The degree of proteinuria, GFR and the level of PTH were interact factors of anemia in elderly patients with CKD.5. Left atrial enlargement was associated with anemia in elderly patients with CKD.