Risk Factors Of Pulmonary Hypertension In Peritoneal Dialysis Patients

Background:Peritoneal dialysis(PD)is a common renal replacement therapy for ESRD patients.Cardiovascular disease(CVD)are the most common causes of mortality in end-stage renal disease(ESRD)patients.Pulmonary hypertension(PH)is a common cardiovascular disease,characterized by a progressive increase in pulmonary vascular resistance and pulmonary artery pressure,leading to right heart failure or even death finally.Peritoneal dialysis patients with Pulmonary hypertension are not uncommon and have a poor prognosis.Prevention of Pulmonary hypertension may be an important goal to improve the prognosis of patients with Peritoneal dialysis.But the pathogenesis of pulmonary hypertension in Peritoneal dialysis patients is remain elusive at present,and the research reports are rare.In order to underatand the risk factors and pathogenesis of pulmonary hypertension in Peritoneal dialysis patients,this research collected clinical date of 177 PD patients.Early identification and active treatment are essential for clinical doctors,aim to improve the quality of life and survival rate of patients with PD.Objective:To explore the prevalence and risk factors of pulmonary hypertension in peritoneal dialysis patients preliminarily.Methods:Retrospective analysis of the clinical data of 177 patients with PD who were admitted to The Second Department of the First Hospital of Jilin University from January 2018 to December 2019.According to the presence or absence of pulmonary hypertension,the patients were divided into pulmonary hypertension group and non-pulmonary hypertension group.The geneal data such as age,sex,dialysis age,height,weight,Body mass index(BMI),systolic blood pressure,diastolic blood pressure,primary disease,history of smoking,past medical history and 24-hour urine output of the two groups were recorded.Collect Hemoglobin(Hb),Serum calcium,Serum phosphate,Calcium-phosphorus product(CaxP),Parathyroid hormone(PTH),creatinine,urea nitrogen,Triglycerides(TG),Total cholesterol(TC),Low density lipoprotein cholesterol(LDL-C),High density lipoprotein cholesterol(HLD-C)Albumin(Alb),Alkaline phosphatase(ALP),Serum sodium,Serum potassium,Serum magnesium,Bicarbonate,Ferritin,C-reative protein(CRP),Fibrinogen(FIB),Blood uric acid,Estimated glomerular filtration rate(eGFR)and other laboratory indicators.The index such as Left atrial diameter(LAD)?Interventricular septal thickness(IVST)?Left ventricular diastolic diameter(LvDd)?left ventricular posterior wall thickness?main pulmonary artery diameter?Left ventricular ejection fraction(LVEF),Ascending aortic diameter,right ventricular diameter,pericardial effusion,mitral regurgitation,aortic regurgitation and other color doppler echocardiography results were detected.Comprare the two groups of patients about the above indicators to find whether there was statistical significance.The above statistical data were analyzed by using SPSS 22.0 statistical software.Results:Of the 177 patients,93 were male and 84 were female.The mean age Was 54.53±12.52 years old and the mean peritoneal dialysis age was 27(16,40)months.There were 37 patients in the PH group and 140 patients in the non-PH group,the occurrence of PH in PD patients is 20.90%.The primary of 178 patients included:82 cases of chronic glomerulonephritis(46.3%),53 cases of diabetic nephropathy(29.9%),25 cases of hypertension(14.1%),17 cases of other reasons(9.6%).There were no significant difference in sex,age,dialysis age,height,weight,Body mass index(BMI),24-hour urine output,diastolic blood pressure,primary disease,history of smoking and other general data between PH group and non-PH group(P>0.05).Three were no significant difference in laboratory such ashemoglobin,parathyroid hormone,urea nitrogen,creatinine,serum sodium,serum potassium,serum calcium,serum phosphate,calcium-phosphorus product,serum magnesium,triglycerides,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,bicarbonate,ferritin,c-reative protein,fibrinogen,alkaline phosphatase,blood uric acid,estimated glomerular filtration rate and other laboratory indicators between PH group and non-PH group(P>0.05).There no significant differenve in ascending aortic diameter,right ventricular diameter,left ventricular posterior wall thickness,the rate of pericardial effusion,the rate of mitral regurgitation,the rate of aortic regurgitation between the two groups(P>0.05).The research showed that the systolic blood pressure,left atrial diameter,Interventricular septal thickness,1eft ventricular diastolic diameter and main pulmonary artery diameter of the PH group were significantly higher than those of the non-PH group.The Left ventricular ejection fraction and serum albumin were significantly lower than those of the non-PH group.The difference between the PH group and the non-PH group was ststistically significant(P<0.05).Further logistic regression analysis showed that high systolic blood pressure,left atrial enlargement and decreased serum albumin are independent factors of PH in PD patients.Conclusion:1?The rate of the pulmonary hypertension in peritoneal dialysis patients is 20.90% in the research.2?Systolic blood pressure,left atrial diameter,interventricular septal thickness,1eft ventricular diastolic diameter,main pulmonary artery diameter,left ventricular ejection fraction and serum albumin may be related to PD patients with pulmonary hypertension.3?High systolic blood pressure,left atrial enlargement and decreased serum albumin are independent factors of PH in PD patients.