| Objective :The aim of this study was to investigate the predictive value of serum alkaline phosphatase(ALP)and red blood cell distribution width(RDW)on the occurrence of cardiovascular events in MHD patients.Methods:Patients with end-stage renal disease who underwent hemodialysis treatment for3 months or more at the Hemodialysis Center of The First Hospital of Kunming from January 1,2020 to December 31,2021 were selected as study subjects.General information(e.g.gender,age,etc.)and biochemical indexes(e.g.ALP,RDW,etc.)were collected from the patients at the time of enrollment,and the patients were followed up every 3 months on an outpatient basis until December 31,2022.During the follow-up period,according to whether cardiovascular events(including unstable angina,myocardial infarction,acute or chronic heart failure,malignant arrhythmia,peripheral artery occlusion,stroke,cardiovascular death)occurred.Patients were divided into an occurrence group and a non-occurrence group.All patients were divided into the H-ALP group(ALP ≥ 90 U/L)and the L-ALP group(ALP < 90U/L)using the median ALP as the cut-off,and then into the H-RDW group(RDW >14.5%)and the L-RDW group(RDW ≤ 14.5%)using the median RDW as the cut-off.The data were analysed and processed using SPSS 25.0 statistical software.The differences between groups were compared using the chi-square test for count data and t-test or non-parametric test for measurement data.The Kaplan-Meier method was applied to plot survival curves,and survival analysis was performed for different groups of ALP and RDW.The Log-rank test was used to compare patients’ morbidity of cardiovascular events.The Spearman correlation method was applied to analyse the correlation of ALP and RDW with other indicators respectively.Cox proportional risk models were constructed for univariate and multifactorial analyses to derive independent risk factors affecting the occurrence of cardiovascular events in patients.P< 0.05 was considered the difference as statistically significant.Results:1.A total of 152 patients with MHD were included in this study,85(55.9%)males and 67(44.1%)females,aged(53.2 ± 15.0)years and 18(8,38)months of dialysis.Among the primary causes of end-stage renal disease,excluding unknown causes,diabetic nephropathy was the most prevalent one,with 45(29.6%),followed by chronic glomerulonephritis,with 31(20.4%).During a mean follow-up period of17.5(12.0,24.0)months,cardiovascular events occurred in 51(33.6%)patients,including heart failure in 29(56.9% of the occurrence group),unstable angina in 7(13.7% of the occurrence group),myocardial infarction in 2(3.9% of the occurrence group),sudden cardiac death in 5(9.8% of the occurrence group),and there were 8cases of malignant arrhythmias(15.7% of the group).There were 101 patients(66.4%)who did not have a cardiovascular event.Age,dialysis age,ALP,RDW,LDL-C,and blood phosphorus were all higher in the group with cardiovascular events than in the group without(P<0.05),and serum albumin was lower in the group with events than in the group without events(P<0.05).2.Survival analysis revealed that the H-RDW group(RDW > 14.5%)had a reduced cardiovascular event-free survival rate compared to the L-RDW group(RDW≤ 14.5%),and the H-ALP group(ALP ≥ 90 U/L)had a statistically significant(P<0.05)reduction in cardiovascular event-free survival rate compared to the L-ALP group(ALP < 90 U/L).Spearman’s correlation analysis of ALP,RDW and other indicators showed that ALP levels were negatively correlated with serum albumin(r=-0.216,P=0.008)and positively correlated with i PTH(r=0.39,P<0.001).RDW levels were negatively correlated with serum albumin(r=-0.55,P<0.001)but positively correlated with vitamin B12(r=0.187,P=0.021)and with TG(r=0.204,P=0.012).3.COX regression analysis showed that RDW(HR=1.223,P=0.036),blood phosphorus(HR=2.305,P=0.008)and age on dialysis(HR=1.018,P=0.001)were independent risk factors for cardiovascular events in patients with MHD.The area of RDW under the ROC curve was 0.646(P < 0.05),with a 95% confidence interval of0.554-0.738,a sensitivity of 0.588,a specificity of 0.792 and a best predictive value of 14.65.The area under the ROC curve for blood phosphorus was 0.619(P < 0.05),with a 95% confidence interval of 0.527-0.712,a sensitivity of 0.608,a specificity of0.673 and a best predictive value of 1.95.The area under the ROC curve for dialysis age was 0.609(p < 0.05),the 95% confidence interval was 0.513-0.706,the sensitivity was 0.353,the specificity was 0.812 and the best predictive value was 36.5.Comparison of the predictive value of different factors for the occurrence of cardiovascular events in patients with MHD: RDW,blood phosphorus and dialysis age combined > RDW > blood phosphorus > dialysis age.Conclusion:1.Baseline ALP and RDW were higher in HD patients with cardiovascular events than those without cardiovascular events;2.Cardiovascular event-free survival is significantly lower in patients with high levels of ALP and RDW compared to those with low levels of ALP and RDW;3.both ALP and RDW can be used as indicators for hypoalbuminemia in patients with MHD;4.RDW,blood phosphorus and dialysis age are independent risk factors for cardiovascular events in patients with MHD.RDW has a good predictive value for the occurrence of cardiovascular events in patients with MHD,with a best predictive value of 14.65,and the predictive value of RDW in combination with blood phosphorus and dialysis age is higher;5.ALP is not an independent influence on the occurrence of cardiovascular events in patients with MHD. |
