The changes of left cardiac structure and function in the patients with non-dialysis chronic kidney disease and influencing factors

Objective To analyze the changes of left ventricular structure and function in the patients with non-dialysis chronic kidney disease (ND-CKD) and the influencing factors. Methods The ND-CKD patients were enrolled from Jan. 2013 to July 2014 in our hospital. All patients were subjected to echocardiography and the indexes were collected. Also the clinical data were collected. The indexes of left ventricular structure and function among different CKD groups were analyzed, and the correlation between the changes of cardiac structure and function were clinical data were also analyzed. Results 337 ND-CKD patients were enrolled, including 71 patients with CKD 1 stage, 37 patients with CKD 2 stage, 28 patients with CKD 3 stage, 36 patients with CKD stage 4 and 165 patients with CKD stage 5. In pace with the progression of CKD, the data revealed that body mass index (BMI) and serum calcium were gradually declined (P<0.05), while blood urea nitrogen (BUN), serum creatinine (SCr), serum phosphorus, intact parathyroid hormone (iPTH) and Cystatin C gradually ascended (P<0.05). New bone metabolic markers revealed that in pace with the progression of CKD, 25-(OH)-VitD gradually declined (P<0.05), but N-Osteocalcin(NOC), β-C-terminal telopeptide of typeⅠcollagen(β-CTX) and N-terminal peptide of typeⅠprocollagen (P1NP) gradually ascended (P<0.05). Echocardiographic indexes revealed that in pace with the progression of CKD, left ventricular end diastolic dimension (LVDd), left ventricular end systolic dimension (LVDs), and left ventricular mass index (LVMI) gradually ascended (P<0.05) in cardiac structure, and SV gradually ascended (P<0.05) in cardiac function, while relative wall thickness (RWT), cardiac output (CO), left ventricular ejection fraction (LV-EF), fractional shortening (FS), and transmitral diastolic early peak inflow velocity/transmitral diastolic late peak inflow velocity(E/A) had no statistically significant difference, but E/A gradually declined and was less than 1 after CKD 2. Left ventricular geometric remodeling revealed that the normal LV geometry group gradually declined from CKD 1 to CKD 5, with 84.5%, 70.3%, 64.3%, 44.4% and 38.2% respectively. The abnormal LV geometry groups gradually ascended from CKD 1 to CKD 5, and there were 32.1% with eccentric hypertrophy, 15.2% with concentric hypertrophy, and 14.5% with concentric remodeling. Multiple linear regression revealed that the risk factors of RWT were age and serum phosphorus, the risk factor of LVDd was BMI, the risk factor of LVMI was β-CTX, the risk factor of SV was Cystatin C, and the protective factors of E/A were age, gender(female), Ca and BUN. Conclusions The left ventricular structure and function in the patients with ND-CKD were aggravated in pace with the progression of CKD. Age, renal function, serum phosphorus, serum calcium, iPTH, BMI and β-CTX were related to the changes of left ventricular structure and function.