| ObjectionThe purpose of this study was to investigate the relationship between red blood cell distribution width(RDW)and pulmonary hypertension(PH)in patients with chronic kidney disease(CKD)stage 3-5,and to evaluate the predictive value of RDW on PH in patients with chronic kidney disease(CKD)stage 3-5,so as to provide clinical basis for early diagnosis and intervention of PH in patients with CKD stage 3-5.MethodsA total of 141 adult patients with CKD stage 3-5 who were admitted to the First Affiliated Hospital of Guangdong Pharmaceutical University and underwent echocardiography from January 2015 to May 2021 were selected according to inclusion and exclusion criteria.The patients’ general information(gender,age,SBD,DBP,smoking history,etc.),previous basic medical history(hypertension,diabetes,coronary heart disease(CHD),etc.),blood routine and biochemical indexes(including: Hemoglobin(Hb),red blood cell distribution width(RDW),total cholesterol(TC),triacylglycerol(TG),low density lipoprotein(LDL),high-density lipoprotein(HDL),serum calcium(Ca),serum phosphorus(P),creatinine(Scr),uric acid(UA),Cystatin(Cys),high sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),serum ferritin(SF),whole parathyroid hormone(i PTH),brain natriuretic peptide(BNP),etc.),cardiac ultrasound indicators(mainly including: The ratio of early diastolic flow to peak velocity of mitral ring motion(E/ e ’),left ventricular ejection fraction(LVEF),left ventricular myocardial weight index(LVMI),pulmonary arterial systolic pressure(PASP),left ventricular end-diastolic diameter(LVDd),left ventricular posterior wall thickness(LVPWD),end-diastolic volume(EDV),end-systolic volume(ESV),stroke output(SV),fractional shortening(FS),right ventricular diameter(RVd),right atrium diameter(RAd),pulmonary artery diameter(PA),pulmonary valve orifice velocity(PV),etc.).Patients were divided into PAH group and non-PAH group according to cardiac ultrasound diagnostic criteria,and the general data and clinical indicators were compared between the two groups respectively.The correlation between RDW and PASP and other clinical indicators was analyzed,the risk factors of PAH were analyzed,and the predictive value of RDW was evaluated by ROC and area under curve(AUC).Results1.A total of 141 subjects were included,including 28 patients with CKD3,33 patients with CKD4,and 80 patients with CKD5.Among 141 patients,49 cases were complicated with pulmonary hypertension(34.8%).The results of this study showed that the incidence of PH was higher in CKD3-5 patients,and the incidence of PH increased with the deterioration of renal function.2.There were 49 patients with PH,with an average age of(72±12)years;92 patients with non-PH,with an average age of(70±10)years.There were no significant differences in gender,average age,SBD,DBP,CHD,hypertension,diabetes mellitus,smoking history,body mass index(BMI),hemodialysis and primary disease of CKD between the two groups.3.The RDW,Cys,i PTH,IL-6,BNP,E/e’,PASP,LVDd,LVMI,ESV,EDV,PA,RAd and RVd in PH group were significantly higher than those in PH group.TG,UA,LVEF and FS in PH group were significantly lower than those in PH group.There were no significant differences in Hb,TC,HDL,LDL,Ca,P,Ca×P,BUN,GFR,ALB,SF,Hs-CRP,LVPWD,SV and PV between PH group and non-p H group.4.E/e’(r=0.244,P=0.004),PASP(r=0.402,P=0.000),ESV(r=0.169,P=0.046),PA(r=0.245,P=0.005),RAd(r=0.263,P=0.002),RVd(r=0.310,P=0.000),CHD(r=0.187,P=0.025),BUN(r=0.247,P=0.003),Cys(r=0.398,P=0.000),i PTH(r=0.243,P=0.018),hs-CRP(r=0.333,P=0.001),IL-6(r=0.239,P=0.023),BNP(r=0.318,P=0.001)were positively correlated with RDW.Hb(r=-0.186,P=0.027),GFR(r=-0.300,P=0.000),UA(r=-0.226,P=0.009)were negatively correlated with RDW.5.E/e’(r=0.314,P=0.000),LVDd(r=0.283,P=0.001),LVMI(r=0.184,P=0.039),ESV(r=0.344,P=0.000),EDV(r=0.283,P=0.001),PA(r=0.301,P=0.000),RAd(r=0.513,P=0.000),RVd(r=0.498,P=0.000),RDW(r=0.402,P=0.000),Cys(r=0.243,P=0.008),i PTH(r=0.353,P=0.000),IL-6(r=0.326,P=0.002),BNP(r=0.312,P=0.001)was positively correlated with PASP.LVEF(r=-0.230,P=0.006),FS(r=-0.233,P=0.006),BMI(r=-0.194,P=0.034),Hb(r=-0.294,P=0.000),TG(r=-0.294,P=0.001),Ca(r=-0.205,P=0.015)were negatively correlated with PASP.6.Multivariate logistic regression analysis showed that PH was positively correlated with RDW.7.ROC curve analysis showed that the AUC of predicting PH by RDW was 0.680.The sensitivity was 59.2%,and the specificity was 71.7%.ConclusionsThe incidence of PH is high in patients with CKD3-5,and RDW examination is of certain value in predicting PH in patients with CKD3-5. |
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