Sun Lianqin, Li Qing, Sun Zhiying, Duan Suyan, Nie Guangyan, Dong Jiaxin, Zhang Chengning, Zeng Ming, Sun Bin, Yuan Yanggang, Wang Ningning, Mao Huijuan, Xing Changying, Zhang Bo
Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China.
Front Nutr. 2022 Feb 25;9:761848. doi: 10.3389/fnut.2022.761848. eCollection 2022.
Volume overload is a frequent feature related to left ventricular hypertrophy (LVH) in dialysis patients, but its influence on patients with chronic kidney disease (CKD) not on dialysis has not been accurately uncovered. This article was to examine the relationship between overhydration (OH) and LVH in patients with CKD not yet on dialysis.
A total of 302 patients with CKD stages 1-4 were included. Participants were divided into different subgroups according to occurring LVH or not, and OH tertiles. Clinical and laboratory parameters were compared among groups. Spearman correlation analyses were adopted to explore the relationships of echocardiographic findings with the clinical and laboratory characteristics. Binary logistic regression models were performed to estimate the odds ratios (ORs) for the associations between OH and LVH. Restricted cubic splines were implemented to assess the possible non-linear relationship between OH and LVH. LVH was defined as left ventricular mass index (LVMI) >115 g/m in men and >95 g/m in women.
Of the enrolled patients with CKD, the mean age was 45.03 ± 15.14 years old, 165 (54.6%) cases were men, and 65 (21.5%) cases had LVH. Spearman correlation analyses revealed that OH was positively correlated with LVMI ( = 0.263, < 0.001). After adjustment for age, gender, diabetes, body mass index (BMI), systolic blood pressure (SBP), hemoglobin, serum albumin, estimated glomerular filtration rate (eGFR), and logarithmic transformation of urinary sodium and urinary protein, multivariate logistic regression analyses demonstrated that both the middle and highest tertile of OH was associated with increased odds of LVH [OR: 3.082 (1.170-8.114), = 0.023; OR: 4.481 (1.332-15.078), = 0.015, respectively], in comparison to the lowest tierce. Restricted cubic spline analyses were employed to investigate the relationship between OH and LVH, which unfolded a significant non-linear association ( for non-linear = 0.0363). Furthermore, patients were divided into two groups according to CKD stages. The multivariate logistic regression analyses uncovered that increased odds of LVH were observed in the middle and the highest tertile of OH [OR: 3.908 (0.975-15.670), = 0.054; OR: 6.347 (1.257-32.054), = 0.025, respectively] in patients with stages 1-2.
These findings suggest that a higher level of OH was associated with a higher occurrence of LVH in patients with CKD not on dialysis, especially in patients with CKD stages 1-2.
容量超负荷是透析患者左心室肥厚（LVH）的常见特征，但其对未接受透析的慢性肾脏病（CKD）患者的影响尚未被准确揭示。本文旨在研究未接受透析的CKD患者水钠潴留（OH）与LVH之间的关系。
共纳入302例1-4期CKD患者。参与者根据是否发生LVH以及OH三分位数分为不同亚组。比较各组的临床和实验室参数。采用Spearman相关分析探讨超声心动图结果与临床和实验室特征之间的关系。进行二元逻辑回归模型以估计OH与LVH之间关联的比值比（OR）。采用受限立方样条评估OH与LVH之间可能的非线性关系。LVH定义为男性左心室质量指数（LVMI）>115 g/m²，女性>95 g/m²。
在纳入的CKD患者中，平均年龄为45.03±15.14岁，165例（54.6%）为男性，65例（21.5%）有LVH。Spearman相关分析显示OH与LVMI呈正相关（r = 0.263，P < 0.001）。在调整年龄、性别、糖尿病、体重指数（BMI）、收缩压（SBP）、血红蛋白、血清白蛋白、估计肾小球滤过率（eGFR）以及尿钠和尿蛋白的对数转换后，多因素逻辑回归分析表明，与最低三分位数相比，OH的中间和最高三分位数均与LVH发生几率增加相关[OR：3.082（1.170 - 8.114），P = 0.023；OR：4.481（1.332 - 15.078），P = 0.015]。采用受限立方样条分析研究OH与LVH之间的关系，发现存在显著的非线性关联（非线性P = 0.0363）。此外，根据CKD分期将患者分为两组。多因素逻辑回归分析发现，在1-2期患者中，OH的中间和最高三分位数与LVH发生几率增加相关[OR：3.908（0.975 - 15.670），P = 0.054；OR：6.347（1.257 - 32.054），P = 0.025]。
这些发现表明，较高水平的OH与未接受透析的CKD患者LVH的较高发生率相关，尤其是在1-2期CKD患者中。
