Levels Of ADMA And Correlation Of Complication Of Chronic Heart Failure In Chronic Kidney Disease Patients

Objective:To explore the correlation of asymmetric dimethylarginine and heart failure in patients with chronic kidney disease(CKD).To confirm that the level of ADMA in population of CKD patients with concurrent HF was higher than the pure patients with CKD.As the rank of CKD grows,The level of asymmetric dimethylarginine become higher.and thus leading to greater risk of heart failure,To provide new diagnostic and therapeutic target for HF in CKD.Methods:Using contrastive study,the selection from May 2017 to November 2017 in shanxi provincial affiliated hospital of shanxi medical university renal medicine CKD patients in hospital,according to whether the patient every half a year is occurring heart dysfunction should be divided into control group and observation group.Control group 39 patients,Detection of ADMA:the enzyme-linked immunosorbent assay(ELISA)determination of two groups of ADMA.Simultaneously measure the blood indexes,routine blood,biochemical,monitoring serum creatinine(Scr),blood urea nitrogen(BUN),hemoglobin(Hb),albumin(propagated),24 hours urinary protein,brain natriuretic peptides(BNP),parathyroid hormone,blood calcium,blood phosphorus;All patients with urinary ultrasound,determination of kidney size,all patients with cardiac ultrasound,and according to the results to calculate left ventricular mass index(LVMI),left ventricular mass index,(LVMI).To compare the differences of ADMA and other clinical biomarkers between observation group and control group.Then to compare serum ADMA of CKD3 and CKD5 patients in two groups.The correlation betweenADMA and BNP and eGFR was statistically analyzed.Finally,multivariate logistic regression analysis was used to analyze the risk factors of heart failure in patients with chronic kidney disease,and ADMA was used to predict the sensitivity and specificity of heart failure in patients with chronic kidney disease.Results:1.Comparison of serum ADMA and blood test indicators between the two groups:the average concentration of ADMA in the control group was 0.369 ± 0.191umol/L,and the observation group was 0.626 ± 0.173).The difference between the two groups was statistically significant(t=5.060,P<0.05).The results showed that there was no statistically significant difference between the two groups of age,hemoglobin,albumin,24-hour urine protein,blood calcium,blood phosphorus,parathyroid gland,kidney size,etc.(P> 0.05).In the observation group,LVM and LVMI were higher than the control group.LVEF was lower than the control group,and the difference was statistically significant(P<0.05).2.Intra group comparative analysis showed that chronic kidney disease patients had a negative correlation between ADMA concentration and eGFR level,and ADMA content in CKD3 patients was lower than CKD5.No matter whether there was heart failure,the higher the CKD stage in chronic kidney disease,the higher the ADMA content in the body was.3.The two group of 59 patients as a whole,according to whether the occurrence of chronic heart failure as the dependent variable,gender,age,history of diabetes mellitus,hemodialysis,peritoneal dialysis,24 hour urinary protein,ADMA Hb,ALB,parathyroid hormone,and other indicators as independent variables,multivariate logistic regression analysis,analysis results show that the high level of the ADMA is a risk factor for chronic heart failure in patients with chronic kidney disease.4.ROC curve analysis showed:The area under the curve of ADMA for the diagnosis of heart failure patients with chronic kidney disease(CKD)is 0.843,and0.75 sensitivity,specific degree is 0.846,cutoff value of 0.544,ADMA can be used as a diagnostic index of heart failure patients with chronic kidney disease.Conclusions:1.In patients with chronic kidney disease complicated with heart failure,the level of ADMA is higher than that of patients with chronic kidney disease,and ADMA is a risk factor for heart failure.It has a diagnostic effect on chronic kidney disease complicated with heart failure.2.ADMA has diagnostic significance for heart failure,and has high accuracy in diagnosing heart failure,with a cut-off point of 0.544,a sensitivity of 0.750,and a specificity of 0.846.The level of ADMA is positively correlated with BNP in patients with chronic renal disease complicated with heart failure.ADMA can be combined with BNP to further improve the laboratory diagnosis of heart failure in patients with chronic kidney disease..3.ADMA is negatively correlated with eGFR.As the CKD rank grows,the ADMA content become higher.It suggests that the kidney may play an important role in the excretion of ADMA,or ADMA may damage the kidneys.4.In kidney disease patients with heart failure,LVMI and LVM were higher than in patients with pure kidney disease,the EF value is less than the patients with pure kidney disease,there were no significant differences in age,weight,24 hours urine protein,serum calcium,suggesting that in patients with chronic kidney disease complicated heart failure,left ventricular hypertrophy increased and ejection fraction reduced.