Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea.
Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea.
PLoS One. 2019 Sep 3;14(9):e0221970. doi: 10.1371/journal.pone.0221970. eCollection 2019.
Chronic fluid overload is common in patients with chronic kidney disease (CKD) and can with time lead to poor prognosis regarding to the cardiovascular events. Serum NT-proBNP and OH/ECW might reflect fluid status of the patients, and the maximal tricuspid regurgitation velocity (TRVmax) could reflect systolic pulmonary artery pressure (SPAP). We investigated the relationship between markers of volume status and marker of pulmonary hypertension (PH) in non-dialysis CKD5 (CKD5-ND) patients.
Bioimpedance spectroscopy (BIS), echocardiography, and measurement of serum NT-proBNP were performed in 137 consecutive patients on the same day. TRVmax greater than or equal to 2.9 m/s, corresponding to SPAP of approximately 36 mmHg, was used as a definition of the possibility of PH in the absence of left heart disease and chronic respiratory disease (PH group).
Patients with possibility of PH (TRVmax ≥ 2.9 m/s) was found in 27 (19.70%) patients. Among the values obtained from BIS, those reflecting the fluid balance (OH, OH/ECW, and E/I ratio) were significantly higher in the PH group. The OH/ECW in patients with PH were significantly higher than those patients without (26.76 ± 15.07 vs. 13.09 ± 15.05, P < 0.001). NT-proBNP was also significantly higher in PH group compared to the non-PH group (median = 10,112 pg/ml, IQR = 30,847 pg/ml vs. median = 1,973 pg/ml, IQR = 7,093 pg/ml, P < 0.001). OH/ECW was positively associated with TRVmax (r = 0.235, P = 0.006). Multivariate logistic regression revealed that increased OH/ECW and serum NT-proBNP were significantly associated with an increased risk of PH.
A significant number of patients showed increased TRVmax, which was closely related to volume status in CKD5-ND patients. Echocardiography and BIS could be important players in a high possibility of PH detection and treatment in asymptomatic CKD patients. Therefore, these measures could be helpful to improve the cardiac outcomes after initiating renal replacement therapy. Further research may be needed to validate the consistency of this association across other stages of CKD.
慢性液体超负荷在慢性肾脏病（CKD）患者中很常见，随着时间的推移，这可能导致心血管事件的预后不良。血清 NT-proBNP 和 OH/ECW 可能反映患者的液体状态，而最大三尖瓣反流速度（TRVmax）可反映收缩期肺动脉压（SPAP）。我们研究了非透析 CKD5（CKD5-ND）患者中容量状态标志物与肺动脉高压（PH）标志物之间的关系。
对 137 例连续患者进行生物电阻抗谱（BIS）、超声心动图和血清 NT-proBNP 测量。当无左心疾病和慢性呼吸道疾病时，TRVmax 大于或等于 2.9m/s（对应于约 36mmHg 的 SPAP）被用作 PH 可能性的定义（PH 组）。
发现 27 例（19.70%）患者存在 PH 的可能性（TRVmax≥2.9m/s）。在 BIS 获得的值中，反映液体平衡的那些值（OH、OH/ECW 和 E/I 比值）在 PH 组中明显更高。PH 组的 OH/ECW 明显高于无 PH 组（26.76±15.07 与 13.09±15.05，P<0.001）。PH 组的 NT-proBNP 也明显高于非 PH 组（中位数=10112pg/ml，IQR=30847pg/ml 与中位数=1973pg/ml，IQR=7093pg/ml，P<0.001）。OH/ECW 与 TRVmax 呈正相关（r=0.235，P=0.006）。多变量 logistic 回归显示，OH/ECW 和血清 NT-proBNP 升高与 PH 风险增加显著相关。
相当数量的患者出现了 TRVmax 增加，这与 CKD5-ND 患者的容量状态密切相关。超声心动图和 BIS 可能是无症状 CKD 患者检测和治疗高 PH 可能性的重要手段。因此，这些措施可能有助于改善开始肾脏替代治疗后的心脏结局。可能需要进一步的研究来验证这种关联在 CKD 的其他阶段的一致性。
