Han Byoung-Geun, Seol Jae Hee, Choi Sooyeon, Shin Donghui, Kim Jae-Seok, Kim Yong Hyuk
Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
J Clin Med. 2023 Aug 3;12(15):5092. doi: 10.3390/jcm12155092.
Patients with chronic kidney disease (CKD) have a high incidence of left ventricular diastolic dysfunction (LVDD), which increases the risk of heart failure and mortality. We assessed fluid overload as an independent risk factor for LVDD in patients with decreased kidney function and compared its impact on the E/e' ratio as a parameter for assessing left ventricular diastolic functions between patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and those with non-dialysis CKD stage 5 (CKD5) using propensity score matching (PSM). After PSM, 222 patients (CAPD, = 111; CKD5, = 111) were included. Fluid balance was assessed using bio-impedance spectroscopy and LVDD was determined by echocardiography based on an E/e' ratio of >15. The CKD5 group had a significantly higher E/e' ratio ( = 0.002), while fluid overload (OH/ECW) did not differ significantly between the groups. In the CAPD group, there were no significant differences in OH/ECW between patients with and without LVDD ( = 0.517). However, in the CKD5 group, patients with LVDD showed a significantly higher OH/ECW ( = 0.001). In a regression analysis investigating factors associated with the E/e' ratio, OH/ECW was not significantly associated with the E/e' ratio in the CAPD group ( = 0.087), but in the CKD5 group, it was independently correlated ( = 0.047). The factors closely associated with LVDD varied depending on dialysis dependence. While fluid overload independently influenced LVDD in non-dialysis patients, it was not statistically significant in patients with CAPD. Early assessment and management of volume status are crucial in addressing LVDD in patients with advanced-stage CKD.
慢性肾脏病（CKD）患者左心室舒张功能障碍（LVDD）的发生率较高，这增加了心力衰竭和死亡风险。我们将液体超负荷评估为肾功能减退患者LVDD的独立危险因素，并使用倾向评分匹配（PSM）比较其对连续非卧床腹膜透析（CAPD）患者和非透析CKD 5期（CKD5）患者左心室舒张功能评估参数E/e'比值的影响。PSM后，纳入了222例患者（CAPD组111例；CKD5组111例）。使用生物电阻抗光谱法评估液体平衡，通过超声心动图基于E/e'比值>15确定LVDD。CKD5组的E/e'比值显著更高（P = 0.002），而两组间液体超负荷（OH/ECW）无显著差异。在CAPD组中,有LVDD和无LVDD的患者之间OH/ECW无显著差异（P = 0.517）。然而,在CKD5组中,有LVDD的患者OH/ECW显著更高（P = 0.001）。在一项调查与E/e'比值相关因素的回归分析中，CAPD组中OH/ECW与E/e'比值无显著关联（P = 0.087），但在CKD5组中,二者独立相关（P = 0.047）。与LVDD密切相关的因素因透析依赖性而异。虽然液体超负荷在非透析患者中独立影响LVDD，但在CAPD患者中无统计学意义。早期评估和管理容量状态对于解决晚期CKD患者的LVDD至关重要。
