Analysis Of Factors Influencing Heart Failure In Patients With Non-dialysis Chronic Kidney Disease Stage 3-5

Objective:To investigate the factors influencing heart failure(HF)in patients with non-dialysis chronic kidney disease stage 3-5(ND-CKD stage 3-5),aiming to provide a certain basis for predicting the occurrence of HF in ND-CKD patients in clinical practice.Methods:A total of 149 ND-CKD3-5 patients were selected as the study subjects based on the inclusion and exclusion criteria of patients hospitalized in the Department of Nephrology of the Seventh Clinical Medical College affiliated to Shanxi Medical University(Linfen People’s Hospital)from March 2021 to June 2022.The general data of sex,age,hypertension,diabetes,coronary heart disease,and cerebrovascular disease were collected,as well as biochemical indexes such as blood routine,renal function,electrolyte,blood lipid,parathyroid hormone,and B-type natriuretic peptide(BNP),and echocardiography.The ND-CKD3-5 patients were divided into the HF and non-HF groups based on whether HF had occurred.SPSS 26 0 software was used for statistical analysis to compare whether the two groups had statistical differences in general information,past medical history,and biochemical indicators.Then,statistically significant indicators were further included in the multivariate Logistic regression model for analysis to determine the independent influencing factors for the occurrence of HF in patients with ND-CKD stage 3-5.Results:1.A total of 149 subjects were included in the study,including 71 patients with HF.Compared with the non-HF group,more patients in the HF group have hypertension and diabetes,with higher levels of red blood cell volume distribution width,blood creatinine,urea nitrogen,cystatin C,parathyroid hormone,blood phosphorus,and BNP,and lower levels of hemoglobin(Hb),estimated glomerular filtration rate(eGFR),bicarbonate concentration,albumin,low-density lipoprotein,and blood calcium.The above differences were statistically significant(P<0.05).The statistically significant indicators were further included in the multivariate Logistic regression model for analysis.The results showed that the history of diabetes(OR=6.870)was an independent risk factor for HF in patients with ND-CKD stage 3-5.Elevated levels of Hb(OR=0.973)and eGFR(OR=0.850)are the protective factors for the occurrence of HF in patients with ND-CKD stage 3-5.2.In the ROC curve of HF occurring in patients with ND-CKD stage 3-5,the area under the curve(AUC)of Hb was 0.785(95%CI 0.710-0.848,P<0.001).When the optimal cutoff value was 96.5g/L,the sensitivity for the diagnosis of HF was 83.1%,and the specificity was 61.5%.The AUC of eGFR was 0.857(95%CI 0.796-0.919,P<0.001).When the optimal cutoff value was 11.5 m L/min/1.73m~2,the sensitivity and specificity for the diagnosis of HF were 74.4%and 88.7%,respectively.3.There was a negative correlation between BNP and eGFR(r=-0.698,P<0.05).Conclusions:1.Hb,eGFR,and diabetes are independent influencing factors for HF in patients with ND-CKD stage 3-5.Timely and effective treatment may reduce or delay the occurrence and progression of HF.2.Hb and eGFR is significant in diagnosing HF in patients with ND-CKD stage 3-5.When Hb≤96.5g/L or eGFR≤11.5 m L/min/1.73m~2,the occurrence of HF should be vigilant in this CKD population.3.BNP is affected by renal insufficiency.When BNP is used to diagnose HF in patients with ND-CKD stage 3-5,the cutoff concentration needs to be increased.