The Correlation Between Nutritional Status And Pulmonary Arterial Hypertension In Maintenance Hemodialysis Patients

Background:The incidence rate of pulmonary hypertension(PH)in the maintenance hemodialysis(MHD)patients significantly higher than the general population were reported by a large number of studies.In recent years.The pathogenesis and risk factors of MHD patients with PH was much complicated,and there was still no definite conclusion,a large of researchers report that vascular endothelial cell damage was a key factor in the MHD patients with PH.In recent years,the risk factors of MHD patients with PH were reported by many researchers,showing that the levels of serum albumin(Alb),hemoglobin(Hb),Body mass index(BMI)and body fat mass in MHD patients were significantly lower than those without PH in MHD patients;and diabetic nephropathy is a risk factor for patients with MHD with PH.In fact,MHD patients had a high incidence of malnutrition;for the MHD patients,the primary disease with diabetes were more likely suffer from malnutrition than the primary disease without diabetes;malnutrition often led to micro-inflammatory state;during the chronic micro-inflammatory state,oxidative stress and increased release of vasoactive neurotransmitters often led to vascular endothelial cell damage,appear pulmonary hypertension at last.At present,the research on the relationship between nutritional status and specific nutritional indexes and systolic pulmonary arterial pressure(PAP)in MHD patients is still lacked,it is worthwhile to discuss the association between malnutrition and PH.Objective:To assess the incidence of the nutritional status and PH in MHD patients,investigate the relationship among nutritional status,specific nutritional indexes and pulmonary artery pressure in MHD patients.To analysis the impact of malnutrition on the development of pulmonary hypertension in MHD patients.Method:94 cases MHD patients were enrolled from 234 cases MHD patients who were treated in the First Affiliated Hospital of Hunan Normal University from March 2016 to June 2016.For all the subjects,the age was from 50 years old to 70 years old,dialysis course>1 year,dialysis frequency was 2 to 3 times/week,4h/times;and which who with acute/chronic lung disease,heart valve disease,active inflammation,malignant disease,immune connective tissue disease and other patients was be excluded.Collected the clinical and demographic data through the Hunan Provincial People's Hospital electronic medical record system.The nutrition status of MHD patients was evaluated by MQSGA score,MQSGA score>14 points was defined as malnutrition;PAP and other cardiac structures and cardiac function indexes(left ventricular mass index(LVMI)and left ventricular ejection fraction(LVEF)in patients with MHD were determined by echocardiography after a midweek HD session.In all the patients blood samples were collected and detected at maximum dialysis interval and fasting state in the morning,including serum albumin(Alb),total protein(TP),preabumin(PA),total cholesterol(TC),triglyceride(TG),creactive protein(hs-CRP),calcium(Ca),phosphorus(P)and parathyroid hormone(PTH);The body measurements were measured include triceps skinfold(TSF),mid-arm circumference(MAC),mid-arm muscle circumference(MAMC),dry weight(DW),height and body mass index(BMI);PH was defined as PAP>35mmHg by the criteria of American Heart Ultrasound Association Right Heart Detection Guideline;The clinical data were analyzed and compared in our study.Results:1.PH(PAP>35mmHg)prevalence was 31.91%(n=30 case)in MHD patients,malnutrition(MQSGA score>14 points)prevalence was 64.89%(n=64 case).2.Dialysis age,the levels of SBP and ID WG were significantly higher in PH group than nPH group(P<0.05);There were no significant difference with DBP,DW,height,gender and phrimary disease composition between PH group and nPH group.3.The levels of Hb,Alb,TP,PA,TSF,MAMC,BMI and LVEF were significantly lower in patients with PH than without PH(P<0.05);The score of MQSGA and the levels of LVMI was significantly higher in patients with PH than without PH(P<0.05).The levels of TC,TG,Hs-CRP,Ca and P between patient with PH and without PH had no significantly difference.4.Based on MQSGA criteria,76.67%of the MHD patients with PH were suffered from mild to moderate malnutrition significantly higher than 53.13%in MHD patients without PH;10%of the MHD patients with PH were suffered from severely malnourished significantly higher than 1.56%in MHD patients without PH(Z=-7.024,P<0.001).The levels of PAP in severely malnourished groups(46.42 ± 2.83)mmHg mmHg was significantly higher than that in the Light-moderate malnutrition groups(35.78±3.02)mmHg mmHg in,and significantly higher than that of the well-nourished groups(21.24±3.29)mmHg(F=39.84,P<0.001).5.The level of PAP and the score of MQSGA in diabetic nephropathy group was significantly higher than that of non-diabetic nephropathy group(P<0.05);The levels of Hb,TP,Alb and TSF in diabetic nephropathy group were significantly lower than that of non-diabetic nephropathy group(P<0.05).The levels of MAC,MAMC,BMI and PA in diabetic group were lower than that of non-diabetic nephropathy group,but there was no statistically difference in two groups(P>0.05).The score of MQSGA were positively correlated with PAP in diabetic nephropathy group and non diabetic nephropathy group;The levels of Hb,Alb,TP,PA,TSF and MAC were negatively correlated with PAP in diabetic nephropathy group.The levels of Hb,Alb,TP and PA were negatively correlated with PAP in non-diabetic nephropathy group.6.For MHD patients,the levels of Hb,Alb,TP,PA,TSF,MAMC,BMI and LVEF was negatively correlated with PAP.The levels of MQSGA score,LVMI,IGWG was positively correlated with PAP.7.Logistic regression analysis revealed that LVMI(B=3.239,P=0.004),Hb(B=-2.654,P=0.007),Alb(B=-2.030,P=0.028),MASGA score(B=3.467,P=0.008)and IDWG(=2.863,P=0.003)was the major risk factor for PH.Conclusion:1.There was a high incidence of malnutrition and PH in MHD patients2.There was a significant association between malnutrition and PH in HD patients,the worse the nutritional status,the higher the pulmonary artery pressure;3.Malnutrition was one of the major risk factors for MHD patients with PH.