Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Department of Ophthalmology, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and Technology, Wuhan, Hubei, China.
Int Urol Nephrol. 2023 Nov;55(11):2915-2924. doi: 10.1007/s11255-023-03576-3. Epub 2023 Apr 3.
To investigate the relationship between the number of valvular insufficiency (VI) and emergency hospitalization or mortality in maintenance hemodialysis (HD) patients.
The maintenance HD patients with cardiac ultrasonography were included. According to the number of VI ≥ 2 or not, the patients were divided into two groups. The difference of emergency hospitalized for acute heart failure, arrhythmia, acute coronary syndrome (ACS) or stroke, cardiovascular mortality, and all-cause mortality between the two groups were compared.
Among 217 maintenance HD patients, 81.57% had VI. 121 (55.76%) patients had two or more VI, and 96 (44.24%) with one VI or not. The study subjects were followed up for a median of 47 (3-107) months. At the end of the follow up, 95 patients died (43.78%), of whom 47 (21.66%) patients died because of cardiovascular disease. Age (HR 1.033, 95% CI 1.007-1.061, P = 0.013), number of VI ≥ 2 (HR 2.035, 95% CI 1.083-3.821, P = 0.027) and albumin (HR 0.935, 95% CI 0.881-0.992, P = 0.027) were independent risk factors for cardiovascular mortality. The three parameters were also independent risk factors for all-cause mortality. The patients with number of VI ≥ 2 were more likely to be emergency hospitalized for acute heart failure (56 [46.28%] vs 11 [11.46%], P = 0.001). On the contrary, the number of VI was not associated with emergency hospitalized for arrhythmia, ACS or stroke. Survival analysis results showed that probability of survival was statistically different in the two groups (P < 0.05), no matter based on cardiovascular mortality or all-cause mortality. Based on age, number of VI ≥ 2 and albumin, nomogram models for 5-year cardiovascular and all-cause mortality were built.
In maintenance HD patients, the prevalence of VI is prominently high. The number of VI ≥ 2 is associated with emergency hospitalized for acute heart failure, cardiovascular and all-cause mortality. Combining age, number of VI ≥ 2, and albumin can predict cardiovascular and all-cause mortality.
探讨维持性血液透析（HD）患者心脏瓣膜反流（VI）数量与急诊住院或死亡的关系。
纳入行心脏超声检查的维持性 HD 患者。根据 VI≥2 或否，将患者分为两组。比较两组间因急性心力衰竭、心律失常、急性冠状动脉综合征（ACS）或卒中急诊住院、心血管死亡率和全因死亡率的差异。
在 217 例维持性 HD 患者中，81.57%存在 VI。121 例（55.76%）患者存在 2 种或以上 VI，96 例（44.24%）存在 1 种或无 VI。中位随访时间为 47（3-107）个月。随访结束时，95 例患者死亡（43.78%），其中 47 例（21.66%）死于心血管疾病。年龄（HR 1.033，95%CI 1.007-1.061，P=0.013）、VI≥2（HR 2.035，95%CI 1.083-3.821，P=0.027）和白蛋白（HR 0.935，95%CI 0.881-0.992，P=0.027）是心血管死亡率的独立危险因素。这 3 个参数也是全因死亡率的独立危险因素。VI≥2 的患者更易因急性心力衰竭急诊住院（56[46.28%] vs 11[11.46%]，P=0.001）。相反，VI 数量与心律失常、ACS 或卒中急诊住院无关。生存分析结果显示，两组间生存概率有统计学差异（P<0.05），无论是基于心血管死亡率还是全因死亡率。基于年龄、VI≥2 和白蛋白，构建了 5 年心血管和全因死亡率的列线图模型。
在维持性 HD 患者中，VI 患病率显著较高。VI≥2 与急性心力衰竭急诊住院、心血管和全因死亡率相关。结合年龄、VI≥2 和白蛋白可以预测心血管和全因死亡率。
