Relationship between β-hydroxybutyrate concentration and left ventricular hypertrophy in patients with diabetic kidney disease

Objective To explore the relationship between β-hydroxybutyrate(β-OHB) concentration and left ventricular hypertrophy(LVH) in patients with diabetic kidney disease(DKD) and provide new therapeutic rationales for DKD with LVH.Methods From February 2021 to November 2021, 99 DKD patients at Taizhou People's Hospital were recruited.Baseline profiles and biochemical parameters of patients were collected, NOD-like receptor protein 3(NLRP3), hypersensitive C-reactive protein(hs-CRP) and interleukin-6(IL-6) in serum were measured by enzyme-linked immunosorbent assay.Color Doppler echocardiography was employed for detecting cardiac structural parameters.They were divided into LVH and non-LVH groups according to the diagnostic criteria for LVH.Non-parametric test was utilized for examining whether or not there were differences in β-OHB between the groups.Logistic regression was employed for examining the risk factors of LVH in DKD patients.The correlation between β-OHB concentration and various indicators of cardiac structure and inflammatory factors in body was analyzed by Spearman's correlation.Results The median age was 62(51, 74) (26-89) years.There were 62 males and the incidence of LVH was 34.3%.Compared with non-LVH group, systolic blood pressure was higher(149.740±4.391) mmHg vs (139.620±2.667) mmHg, 1 mmHg=0.133 kPa, proportion of males(41.2% vs 73.8%), hemoglobin117.5(85.0, 131.0) g/L vs 125.0(107.0, 140.0) g/L, RBC count3.98(2.84, 4.27)×10¹²/L vs 4.13(3.59, 4.73)×10¹²/Land RBC specific volume33.15(24.90, 37.28)% vs 36.30(32.15, 40.65)%were lower, the differences were statistically significant(all P<0.05).Spearman's correlation analysis revealed that NLRP3(r=-0.219, P=0.03), hs-CRP(r=-0.254, P=0.011), IL-6(r=-0.218, P=0.03), left atrial diameter(r=-0.385, P=0.001), interventricularseptal thickness(r=-0.228, P=0.023), left ventricular mass index(r=-0.238, P=0.013) and hemoglobin(r=0.241, P=0.016) were correlated with β-OHB.Multivariate Logistic regression revealed that elevated systolic blood pressure was an independent risk factor.Male and β-OHB concentration were independent protective factors for LVH in DKD patients.Conclusion Elevated systolic blood pressure is an independent risk factor for LVH in DKD patients and β-OHB concentration ≥ 0.15 mmol/L is an independent protective factor for LVH in DKD patients.Compared with non-LVH group, the concentration of β-OHB is lower in DKD group with LVH and β-OHB is negatively correlated with NLRP3.β-OHB may attenuate left ventricular hypertrophy in DKD patients through an inhibition of NLRP3 activating inflammatory factors.