A Clinical Study Of Red Blood Cell Distribution Width And Left Ventricular Diastolic Dysfunction In Patients With Chronic Kidney Disease

ObjectionThe purpose of this study was to investigate the relationship between red blood cell distribution width(RDW)and left ventricular diastolic dysfunction(LVDD)in patients with chronic kidney disease(CKD),and to evaluate the predictive value of RDW for LVDD in CKD patients and provide clinical basis for early diagnosis and intervention.MethodsInclusion criteria: Adult CKD patients who were hospitalized in the First Affiliated Hospital of Guangdong Pharmaceutical University from January 2015 to February 2020 with echocardiography were selected.Exclusion criteria: 1.acute heart failure,2.acute myocardial infarction,3.cardiomyopathy,4.severe infection,5.persistent atrial fibrillation,6.severe pericardial effusion,7.severe valvular disease,8.acute kidney injury based on chronic kidney disease,9.systemic lupus erythematosus,etc.The patients were divided into the normal left ventricular diastolic function group and the LVDD group.The general data(gender,age,height,weight,smoking history,etc.),medical history(hypertension,diabetes,coronary heart disease,etc.),blood routine(hemoglobin(Hb),red blood cell distribution width(RDW),biochemical indexes(serum albumin(Alb),creatinine(SCr),uric acid(UA),serum calcium(Ca),Phosphorus(P),triacylglycerol(TG),low density lipoprotein(LDL),high density lipoprotein(HDL),cholesterol(TC),parathyroid hormone(iPTH),brain natriuretic peptide(BNP),Cystatin(Cys),high-sensitivity troponin I(hs-CTnI),etc.),and echocardiographic indexes(left ventricular end-diastolic diameter(LVDd),left ventricular posterior wall thickness(LVPWD),peak mitral velocity versus valvular annulus motion velocity(E/e'),mitral valve blood flow Peak early and late diastolic velocity ratio(E/A),ejection fraction(EF),left ventricular myocardial weight index(LVMI),early mitral annular diastolic velocity(e'),E deceleration time(DT),end-systolic volume(ESV),end-diastolic volume(EDV),stroke volume(SV),interventricular septal thickness(IVST)and fractional shortening(FS))were recorded.According to the criteria of echocardiography,the patients were divided into two groups:normal left ventricular diastolic function group and LVDD group.The general data and clinical indicators were compared between the two groups,and the correlation between RDW and E/E' and other clinical indicators was analyzed.The risk factors of LVDD were analyzed.ROC curve and area under the curve(AUC)were used to evaluate the predictive value of RDW.Results1.A total of 132 patients were included,including 6 in CKD1-2,25 in CKD3,21 in CKD4 and 80 in CKD5.There were 73 cases of LVDD in 132 CKD patients,and the incidence was 55.3%.LVDD was present in the early stage of CKD,and the incidence rate was increasing along with the development of CKD.2.There were 59 patients with normal left ventricular diastolic function,with an average age of 64±17 years;73 patients with LVDD,with an average age of 68±15 years.Systolic blood pressure and RDW of LVDD group were higher than those of normal left ventricular diastolic function group(P < 0.05).The proportion of coronary heart disease in the LVDD group was higher than that in the normal left ventricular diastolic function group(P = 0.037).There was no significant difference in gender,age,diastolic pressure,BMI,hypertension,diabetes,smoking history,hemodialysis,CKD primary disease,Hb,UA,eGFR,Alb,TC,TG,HDL,LDL,Cys,i PTH,Ca,P,Ca ×P between the two groups.3.There were significant differences between the two groups in the indexes of color Doppler echocardiography,including LVDd,e ',LVMI,ESV,EDV,SV and E /e'(P < 0.05).LVMI and E/e' of LVDD group were significantly higher than that of normal left ventricular diastolic function group,and e' was lower than that of normal left ventricular diastolic function group.4.Univariate correlation analysis showed that RDW was positively correlated with E /e',IVST,P,Ca × P,Cys,and BNP,and negatively correlated with eGFR and Hb.E/e' is positively correlated with LVDd,LVMI,ESV,EDV,E/A,P,Ca×P,Cys,and RDW,and E/e' is negatively correlated with e',eGFR,Hb,TC and LDL.5.Multivariate logistic regression analysis showed that LVDD was positively correlated with RDW and negatively correlated with HB.6.ROC curve analysis showed that the area under curve(AUC)ofLVDD predicted by RDW was 0.612,the sensitivity was 78.9%,and the specificity was 50.8%.ConclusionsLeft ventricular diastolic dysfunction is more likely to occur in patients with CKD.Detection of red blood cell distribution width is of certain value in predicting left ventricular diastolic dysfunction in CKD patients.