Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China.
Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China.
Ren Fail. 2023;45(2):2261786. doi: 10.1080/0886022X.2023.2261786. Epub 2023 Oct 1.
Peritoneal dialysis (PD) patients have a high incidence of cardiovascular events (CVEs). Left ventricular fraction shortening (LVFS), one of the echocardiographic parameters, is an independent risk factor for mortality in previous studies. The aim of this study was to evaluate associations between LVFS and CVEs in PD patients.
This was a single-center observational cohort study. Seven hundred and eighty-four PD patients were enrolled from 1 January 2012 to 1 June 2021 and followed until 1 June 2022. The primary outcome was the incidence of CVEs. PD patients were categorized into three groups according to the tertiles of LVFS levels (tertile 1-tertile 3). Kaplan-Meier method, Cox proportional hazard models and competing risk regression models were used for survival analysis. The areas under the curve (AUC) of receiver-operating characteristic analysis was used to determine the predictive values of LVFS for CVEs. A preplanned subgroup analysis was assessed according to age, gender, and the presence of hypertension and dyslipidemia, etc.
During a median follow-up period of 42.3 months (interquartile range 24.0-79.0 months), 259 CVEs occurred. Compared to the other two groups respectively, patients in tertile 3 group had the lowest incidence of CVEs (24.5% vs 31.6% vs 43.0%, respectively, < 0.05). After multiple adjustments, the tertile 3 group was associated with the 45.1% decrease in the CVEs hazard compared to that of the tertile1 group (SHR = 0.549, 95%CI: 0.395-0.762, < 0.001). Subgroup analysis demonstrated that tertile 1 group as the reference, the association between LVFS and CVEs in tertile 3 group was robust among female patients (HR = 0.506, 95%CI: 0.309-0.829, = 0.007), aged < 45 years (HR = 0.496, 95%CI: 0.331-0.744, = 0.001), history of hypertension (HR = 0.586, 95%CI: 0.349-0.872, = 0.008) and combined with dyslipidemia (HR = 0.464, 95%CI: 0.269-0.799, = 0.006).
This study suggests that LVFS is independently associated with the increased risk of CVEs in PD patients, especially those with aged < 45 years, female, with hypertension and dyslipidemia.
腹膜透析（PD）患者心血管事件（CVE）的发生率较高。左心室短轴缩短率（LVFS）是超声心动图参数之一，是既往研究中死亡的独立危险因素。本研究旨在评估 PD 患者 LVFS 与 CVE 之间的关系。
这是一项单中心观察性队列研究。纳入了 2012 年 1 月 1 日至 2021 年 6 月 1 日期间的 784 名 PD 患者，并随访至 2022 年 6 月 1 日。主要结局为 CVE 的发生率。根据 LVFS 水平的三分位（三分位 1-三分位 3）将 PD 患者分为三组。Kaplan-Meier 法、Cox 比例风险模型和竞争风险回归模型用于生存分析。受试者工作特征（ROC）曲线下面积（AUC）用于确定 LVFS 对 CVE 的预测价值。根据年龄、性别、高血压和血脂异常等情况进行了预先计划的亚组分析。
在中位随访 42.3 个月（四分位间距 24.0-79.0 个月）期间，发生了 259 例 CVE。与其他两组相比，三分位 3 组的 CVE 发生率最低（分别为 24.5%、31.6%和 43.0%，均<0.05）。经过多次调整后，与三分位 1 组相比，三分位 3 组的 CVE 风险降低了 45.1%（SHR=0.549，95%CI：0.395-0.762，<0.001）。亚组分析表明，三分位 1 组为参照，三分位 3 组的 LVFS 与 CVE 之间的关联在女性患者中较为稳健（HR=0.506，95%CI：0.309-0.829，=0.007）、年龄<45 岁（HR=0.496，95%CI：0.331-0.744，=0.001）、高血压病史（HR=0.586，95%CI：0.349-0.872，=0.008）和合并血脂异常（HR=0.464，95%CI：0.269-0.799，=0.006）。
本研究表明，LVFS 与 PD 患者 CVE 风险增加独立相关，尤其是年龄<45 岁、女性、合并高血压和血脂异常的患者。
