Choi Sun Ryoung, Lee Young-Ki, Park Hayne Cho, Kim Do Hyoung, Cho AJin, Kim Juhee, Yun Kyu Sang, Noh Jung-Woo, Kang Min-Kyung
Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Republic of Korea.
Kidney Research Institute, Hallym University, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2022 Jan;41(1):77-88. doi: 10.23876/j.krcp.21.096. Epub 2021 Nov 30.
Patients with end-stage kidney disease face increased risk of cardiovascular events, and left ventricular diastolic dysfunction (LVDD) contributes to the high occurrence of cardiovascular mortality (CM). Although a high serum aldosterone (sALD) level is involved in the development of cardiovascular complications in the general population, this association is unclear in patients undergoing hemodialysis. We aimed to determine the impact of sALD on LVDD and CM among hemodialysis patients (HDPs).
We performed a prospective cohort study of maintenance HDPs without cardiovascular disease. The patients were divided into two groups according to the median level of sALD. All patients underwent baseline echocardiography to evaluate diastolic dysfunction (E/e' ratio > 15). The LVDD and CM rates were compared between the high and low aldosterone groups.
We enrolled a total of 60 adult patients (mean age, 57.9 ± 12.1 years; males, 30.0%). The low aldosterone group had an increased left ventricular diastolic dimension compared with the high aldosterone group (52.2 ± 8.4 mm vs. 50.3 ± 5.2 mm, respectively; p = 0.03). Low log-aldosterone (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.19-0.86) and large left atrial dimension (OR, 1.31; 95% CI, 1.11-1.54) were independent risk factors for LVDD at baseline. In addition, Cox regression analysis demonstrated that low sALD was an independent predictor of CM in HDPs (hazard ratio, 0.46; 95% CI, 0.25-0.85; p = 0.01) during follow-up.
Low sALD was not only associated with LVDD but was also an independent predictor of CM among HDPs regardless of their interdialytic weight gain.
终末期肾病患者面临心血管事件风险增加，而左心室舒张功能障碍（LVDD）导致心血管死亡率（CM）高发。尽管高血清醛固酮（sALD）水平与普通人群心血管并发症的发生有关，但这种关联在接受血液透析的患者中尚不清楚。我们旨在确定sALD对血液透析患者（HDPs）LVDD和CM的影响。
我们对无心血管疾病的维持性HDPs进行了一项前瞻性队列研究。根据sALD的中位数水平将患者分为两组。所有患者均接受基线超声心动图检查以评估舒张功能障碍（E/e'比值>15）。比较高醛固酮组和低醛固酮组的LVDD和CM发生率。
我们共纳入60例成年患者（平均年龄，57.9±12.1岁；男性，30.0%）。与高醛固酮组相比，低醛固酮组的左心室舒张内径增加（分别为52.2±8.4mm和50.3±5.2mm；p=0.03）。低log-醛固酮（优势比[OR]，0.40；95%置信区间[CI]，0.19-0.86）和大左心房内径（OR，1.31；95%CI，1.11-1.54）是基线时LVDD的独立危险因素。此外，Cox回归分析表明，低sALD是随访期间HDPs中CM的独立预测因子（风险比，0.46；95%CI，0.25-0.85；p=0.01）。
低sALD不仅与LVDD相关，而且是HDPs中CM的独立预测因子，无论其透析间期体重增加情况如何。
