Correlation Study Of MHR,CHR And Left Ventricular Hypertrophy In Combination With Chronic Kidney Disease

BackgroundThe incidence of chronic kidney disease(CKD)is on the rise worldwide,affecting approximately13% of the world’s population,with higher mortality rates in developing countries due to poor access to renal replacement therapy.Cardiovascular disease(CVD)is the most dangerous of the many complications of CKD and is the leading cause of death in CKD.The most common manifestation of cardiovascular disease is left ventricular hypertrophy(LVH),which can cause heart failure,arrhythmias,and other common complications.Prevention of cardiovascular disease is essential as it can delay the progression of CKD and reduce the risk of various adverse cardiovascular outcomes due to CKD.Risk factors for cardiovascular disease include traditional risk factors(obesity,diabetes,hypertension,dyslipidemia)and nontraditional risk factors(inflammation,endothelial dysfunction,oxidative stress),which are closely associated with the development of chronic kidney disease.Although inflammation as a common risk factor for chronic kidney disease and cardiovascular disease is easy to detect in the clinic,a single inflammatory factor is susceptible to interference by external factors and ethnic differences,resulting in low reliability and robustness,which limits its use in the clinic.Monocyte to HDL ratio(MHR)and c-reactive protein to HDL ratio(CHR)are new composite inflammatory factors that combine different biochemical parameters to balance inflammation and immune status and have better predictive power than single inflammatory factors.It has a better predictive ability than a single inflammatory factor and is more reliable and robust.Therefore,monitoring the progression of chronic kidney disease by measuring MHR,CHR,and other compound inflammatory factors has more reliable and robust results,which can reduce the risk of disability and death from CKD combined with CVD and reduce the burden on society and families.ObjectiveThe purpose of this study was to observe the relationship between the severity of chronic kidney disease and left ventricular hypertrophy,and the predictive value of MHR and CHR for chronic kidney disease combined with left ventricular hypertrophy.Materials and methods1.Study population: 500 patients with CKD who did not enter renal replacement therapy in the nephrology department of Henan University Huaihe Hospital from September 2019 to September 2022,including 271 males and 229 females with a mean age of(49.6±33.6)years.2.Experimental methods and grouping: this study was a cross-sectional study.Part I: According to the diagnostic criteria of K/DIGO guidelines,the study subjects were divided into 3 groups: group A CKD stage 1-3(154 cases);Group B CKD stage 4(72 cases);Group C CKD stage 5(274 cases).One-way ANOVA was used to compare the differences in clinical test indexes between different stages of CKD.Part II: Divided into LVH group(210 cases)and non-LVH group(290 cases),an independent sample t-test was used to compare the difference of baseline information between the two groups,and the meaningful indexes were analyzed by multi-factor logistic regression for their relationship with LVH.Part III: The predictive value of MHR and CHR for CKD combined with LVH was compared by receiver operating characteristic curve(ROC)analysis,and the difference of P < 0.05 was statistically significant.Results1.A one-way ANOVA was used to analyze the test indexes for different stages of CKD.Glutathione,urea,creatinine,glomerular filtration rate,potassium,calcium,phosphorus,parathyroid hormone,triglycerides,HDL,LDL,monocytes,C-reactive protein,septal thickness,LV end-diastolic internal diameter,LV posterior wall thickness,and LV hypertrophy were statistically significant(P value <0.05).With increasing CKD stage,there was an increasing trend of urea,creatinine,potassium,phosphorus,parathyroid hormone,triglyceride,low-density lipoprotein,monocyte,C-reactive protein,septal thickness,LV end-diastolic internal diameter,LV posterior wall thickness,and LV hypertrophy;and a decreasing trend of glomerular filtration rate,glutathione transaminase,calcium,and high-density lipoprotein.There was no statistically significant difference in age,sex,height,weight,body mass index,ghrelin,albumin,uric acid,total protein,bicarbonate,glucose,white blood cells,neutrophils,lymphocytes,hemoglobin,total cholesterol,and C-reactive protein(P value > 0.05).2.Independent samples t-test was used to compare the LVH and non-LVH groups,and the results showed statistically significant differences in MHR,CHR,glomerular filtration rate,albumin,urea,creatinine,phosphorus,leukocytes,neutrophils,triglycerides,HDL,LDL,and monocytes(p-value < 0.05).Multifactorial logistic regression analysis showed that MHR(z=10.015,p<0.01,OR 365.805),CHR(z=6.042,p<0.01,OR 1.185),urea,and neutrophils were independently positively correlated with LVH;glomerular filtration rate and albumin were independently negatively correlated with LVH.3.ROC curve analysis showed that the area under the curve(AUC)of MHR predicted CKD combined with LVH was 0.823(95% CI 0.784-0.861,P<0.05),with a diagnostic threshold of 2.70,the sensitivity of 72.9% and specificity of 67.6%;the area under the curve(AUC)of CHR predicted CKD combined with LVH was 0.72(95% CI 0.674-0.766,P<0.05),with a diagnostic threshold of 0.43,the sensitivity of 71.4% and specificity of 85.9%.CI 0.674-0.766,P<0.05),with a diagnostic threshold of 0.43,a sensitivity of 71.4%,and a specificity of 85.9%,both of which could predict CKD combined with LVH,but the area under the ROC curve of MHR was larger than that of CHR,suggesting a higher predictive value of MHR.Conclusion1.Detection of MHR,CHR can predict left ventricular hypertrophy in combination with chronic kidney disease.2.Compared to CHR,MHR has a higher predictive value for chronic kidney disease combined with left ventricular hypertrophy.