The Association Of Monocyte To High-density Lipoprotein Ratio With Cardiovascular And Cerebrovascular Events In The Patients On Peritoneal Dialysis

Objectives:Recently,monocyte to high-density lipoprotein ratio(MHR) has been used to predict cardiovascular and cerebrovascular events in multiple disciplines.However,the relationship between MHR and cardiovascular and cerebrovascular events in peritoneal dialysis(PD) patients has not been studied.This study was trying to investigate the association of the MHR and cardiovascular and cerebrovascular events in PD patients.Methods:This is a single center and retrospective study.The peritoneal dialysis patients were chosen in the PD center of our hospital from November 1,2005 to February 28,2017.They were followed until May 31,2017.According to the inclusion and exclusion criteria,patients were screened strictly.The primary endpoint of this study was cardiovascular and cerebrovascular events.Participants were stratified tri-sectional quantiles according to the baseline MHR: T1(low MHR group),T2(moderate MHR group),T3(high MHR group).The risk factors of CV and cerebrovascular events was assessed by Cox regression model.P<0.05,it was considered statistically significant.Results:About 1011 patients were regularly follow-up in our hospital.According to the inclusion and exclusion criteria,a total of 880 patients were finally included in the study.(1)Mean age of the study was 49.40±14.57 years.Of the participants,500(56.8%) were men and 169(19.2%) were diabetic patients.The median follow-up period was 29.5 months(range,3-138 months).(2)The leading cause of ESRD was chronic glomerulonephritis,which accounted for 64.5% of the group,followed by diabetic nephropathy(16.1%) and hypertensive nephropathy(12.3%).Cardiovascular and cerebrovascular events appeared in 139 patients at the end of follow-up.(3)Correlation between MHR and parameters of lipid and inflammation: the ratio of MHR was positively correlated with white blood cell,the ratio of neutrophils/lymphocytes,C-reactive protein and ferroprotein(r=0.418,0.075,0.158 and 0.166,respectively).(4)The cardiovascular and cerebrovascular events-free survival rate at the end of 1,3,and 5 years was(respectively) 92.6%,78.0%,58.0% for high MHR group.The cardiovascular and cerebrovascular events-free survival rate in the T3 group was lowest among these groups(Log-Rank=8.070,P=0.018).The univariate Cox regression analysis found:age,sex,diabetes,leukocyte,platelet,neutrophils to lymphocytes ratio,albumin,serum magnesium,C-reactive protein,apolipoprotein A1,and high MHR were considered statistically significant for cardiovascular and cerebrovascular events.After adjustment for those factors,patients with higher MHR(≥0.42)group was found a significantly higher risk of cardiovascular and cerebrovascular events compared with the lower MHR group(<0.25)(HR=2.671,95%CI:1.512-4.717,P=0.001).Conclusion:(1)MHR was positively correlated with C-reactive protein,ferritin and other inflammatory indicators.It was indicated that this ratio was related to the systemic inflammatory of patients.(2)An increased MHR was associated with cardiovascular and cerebrovascular events in peritoneal dialysis patients.