Factors associated with risk analysis for asymptomatic left ventricular diastolic dysfunction in nondialysis patients with chronic kidney disease

Figures & data

Figure 1. Flow diagram for recruitment of participants in the study.

Figure 2. Algorithm for diagnosis of LVDD in subjects with normal LVEF [24].

Figure 3. The proportion of ALVDD in nondialysis CKD stages 1–5.

Figure 4. The proportion of ALVDD in nondialysis CKD classified by causes.

Table 1. Comparison of baseline data between LVDD and nLVDD in CKD patients.

Baseline data	Normal range	LVDD	nLVDD	χ^2/t/Z value	OR (95% CI)	p
Age (year,$\overline{\chi }$ ± s)		48.68 ± 11.43	31.50 ± 10.67	−7.130	1.144 (1.090–1.201)	.001
Gender (numbers, (male/female))		234/81	18/6	0.006	0.963 (0.370–2.513)	.938
BMI (kg/m^2,$\overline{\chi }$ ± s)	18.50–23.90	24.28 ± 3.59	23.39 ± 2.38	−1.198	1.077 (0.954–1.216)	.232
SBP (mmHg,$\overline{\chi }$ ± s)	90.00–120.00	139.46 ± 18.94	134.71 ± 17.04	1.113	1.013 (0.988–1.039)	.267
DBP (mmHg,$\overline{\chi }$ ± s)	60.00–80.00	85.08 ± 9.90	85.87 ± 11.34	0.333	0.992 (0.948–1.038)	.740
MAP (mmHg,$\overline{\chi }$ ± s)	70.00–105.00	103.60 ± 11.12	100.60 ± 79.86	−1.256	1.024 (0.987–1.062)	.210
Smoking
Current (numbers, %)		155, 49.21	12, 50.00	0.015	1.070 (0.276–4.155)	.922
Ex-smoker (numbers, %)		38, 12.03	3, 12.50	0.015	1.020 (0.274–3.794)	.977
CKD stage (numbers, (1/2/3/4/5))		51/30/39/14/181	6/3/3/1/11	−0.443	1.038 (0.764–1.441)	.658
Disease classification (numbers, (1/2/3/4))		147/141/9/18	6/12/3/3	9.245	4.082 (3.304–17.857)	.020
(DN + HTN)/(CGN + NS + IgAN)					2.080 (0.760–5.710)	.153
(DN + HTN)/CIN					8.197 (1.748–38.461)	.008
(DN + HTN)/(PKD + other types)					4.082 (2.304–17.857)	.046
Laboratory data
NT-Pro-BNP (pg/mL, (M,Q))	0.00–125.00	3557.00, 5681.75	685.00, 2796.95	−0.685	1.000 (1.000–1.000)	.493
eGFR (mL/min/1.73 m^2, (M,Q))	>90.00	12.34, 24.50	14.61, 31.02	−0.253	0.996 (0.984–1.009)	.800
Serum creatinine (μmol/L, (M,Q))	52.20–119.30	423.00, 457.00	448.50, 648.75	−0.447	1.000 (0.999–1.001)	.655
Blood urea nitrogen (mmol/L, (M,Q))	2.90–7.50	16.72, 11.90	14.62, 17.83	−0.175	1.002 (0.993–1.010)	.861
Cystatin C (mg/L)	0.51–1.09	3.11, 2.11	2.73, 2.05	−0.383	1.015 (0.781–1.320)	.702
Blood calcium stratification (number, (0/1))	2.25–2.75 mmol/L	243/72	21/3	−1.177	0.482 (0.140–1.664)	.239
Blood phosphorus stratification (number, (0/1/2))	0.96–1.61 mmol/L	51/189/75	1/14/9	−2.226	2.220 (1.500–4.505)	.026
PTH (pg/mL, (M,Q))	15.0–65.0	188.15, 172.66	142.76, 81.88	−1.142	1.002 (0.998–1.006)	.256
Hemoglobin A1c (%, (M,Q))	4.00–6.00	5.50, 1.60	5.50, 2.00	−1.423	1.604 (0.961–2.667)	.155
Hemoglobin (g/L,$\overline{\chi }$ ± s)	115.00–175.00	104.85 ± 23.04	113.13 ± 22.60	1.699	0.985 (0.968–1.002)	.092
Total cholesterol (mmol/L, (M,Q))	3.10–5.69	4.00, 1.32	3.45, 1.81	−1.149	1.310 (0.844–2.033)	.251
Triacylglycerol (mmol/L, (M,Q))	0.56–1.47	1.45, 1.09	1.54, 0.97	−0.107	1.331 (0.867–2.042)	.914
LDL (mmol/L, (M,Q))	2.07–3.10	2.51, 1.195	2.43, 1.79	−0.947	1.345 (0.901–2.008)	.344
HDL (mmol/L, (M,Q))	1.16–1.42	0.91, 0.37	0.96, 0.33	−0.209	0.791 (0.189–3.317)	.834
Lipoprotein(a) (mg/L, (M,Q))	1.22–1.61	310.50, 354.50	162.00, 192.00	−1.970	1.002 (1.000–1.005)	.049
CRP (mg/L, (M,Q))	0.00–10.00	1.60, 3.00	1.00, 11.00	−0.612	0.952 (0.924–0.980)	.541
ESR (mm/h, (M,Q))	0.00–20.00	30.00, 35.00	18.00, 11.00	−1.685	1.017 (0.933–1.042)	.092
Urine protein (g/24 h, (M,Q))	0.00–0.15	3.92, 4.39	2.64, 3.16	−1.322	1.264 (0.964–1.564)	.186
Urine microalbumin (mg/24 h, (M,Q))	0.00–25.00	1165.60, 1509.00	426.05, 1367.25	−2.196	1.000 (0.999–1.001)	.028
Echocardiographic indicators
LVEF (%, $\overline{\chi }$ ± s)	55.00–70.00	66.78 ± 6.33	65.58 ± 6.00	0.830		.408
LVDd (mm,$\overline{\chi }$ ± s)	35.00–55.00	50.33 ± 6.46	51.67 ± 7.47	−0.872		.385
LVDs (mm,$\overline{\chi }$ ± s)	23.00–36.00	31.62 ± 5.70	33.08 ± 6.31	−1.097		.275
EDVI (mL/m^2,$\overline{\chi }$ ± s)	42.00–124.00	69.07 ± 19.55	73.92 ± 23.14	−1.023		.309
E (cm/s,$\overline{\chi }$ ± s)	60.00–90.00	70.03 ± 21.52	97.88 ± 25.31	−5.422		.001
A (cm/s,$\overline{\chi }$ ± s)	50.00–70.00	94.01 ± 19.95	75.29 ± 22.31	3.984		.001
e′ (cm/s,$\overline{\chi }$ ± s)	>10.00	7.33 ± 1.51	8.54 ± 2.11	−2.168		.036
E/A ($\overline{\chi }$ ± s)	1.00–1.50	0.75 ± 0.24	1.32 ± 0.17	−10.859		.001
E/e′ ($\overline{\chi }$ ± s)	<8.00	12.21 ± 5.19	9.05 ± 4.07	−1.685		.100
LVMI (g/m^2,$\overline{\chi }$ ± s)	70.00–95.00	95.76 ± 35.00	93.40 ± 44.51	−0.272		.786
Comorbidities
Hypertension (yes/no)		255/60	16/8	2.017	2.125 (0.869–5.196)	.111
Diabetes mellitus (yes/no)		112/203	6/18	1.095	1.655 (0.639–4.290)	.295
Dyslipidemia (yes/no)		74/241	5/19	0.088	1.106 (0.399–3.066)	.766
CCI		3.14 ± 1.27	2.41 ± 1.50	−2.401		.018
Medications
ACEIs/ARBs (yes/no)		96/219	9/15	0.515	0.731 (0.309–1.727)	.473
β blockers (yes/no)		123/192	9/15	0.022	1.068 (0.453–2.515)	.881
CCBs (yes/no)		222/93	15/9	0.674	1.432 (0.605–3.388)	.411
Diuretics (yes/no)		69/246	1/23	3.512	6.711 (0.895–50.000)	.061
MRA (yes/no)		68/247	6/18	0.152	0.826 (0.316–2.162)	.696
ARNI (yes/no)		82/233	5/19	0.316	1.337 (0.484–3.697)	.574
Metformin (yes/no)		7/308	2/22	1.292	4.000 (0.784–20.414)	.256
SGLT-2i (yes/no)		77/238	8/16	0.938	0.647 (0.267–1.571)	.333
DPP4i (yes/no)		12/303	1/23	0.008	0.911 (0.113–7.317)	.930
GL-P1RAs (yes/no)		27/288	2/22	0.000	1.073 (0.240–4.803)	1.000

$\overline{\chi }$′c ± s, mean ± standard deviation; M: median; Q: quartile; OR: odds ratio; 95% CI: 95% confidence interval; LVDD: left ventricular diastolic dysfunction; nLVDD: normal left ventricular diastolic function; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure. CKD stage 1, eGFR ≥ 90 mL/min/1.73 m²; 2, eGFR 60–90 mL/min/1.73 m²; 3, eGFR 30–60 mL/min/1.73 m²; 4, eGFR 15–30 mL/min/1.73 m²; 5, eGFR < 15 mL/min/1.73 m². Disease 1, DN (diabetic nephropathy) or HTN (hypertensive nephropathy); 2, CGN (chronic glomerulonephritis) or NS (nephrotic syndrome) or IgAN (IgA nephropathy); 3, CIN (chronic interstitial nephritis); 4, PKD (polycystic kidney disease) or other causes of CKD. NT-Pro-BNP; N-terminal pro-brain natriuretic peptide; eGFR: estimated glomerular filtration rate. Blood calcium stratification 0, normal blood calcium; 1, hypocalcemia. Blood phosphorus stratification 0, hypophosphatemia; 1, normal blood phosphorus; 2, hyperphosphatemia. PTH: parathyroid hormone; LDL: low-density lipoprotein; HDL: high-density lipoprotein; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; LVEF: left ventricular ejection fraction; LVDd: left ventricular end-diastolic diameter; LVDs: left ventricular end-systolic diameter; EDVI: end-diastolic volume index; E: early diastolic transmitral flow; A: late diastolic transmitral flow; e′: early diastolic mitral annular velocity; LVMI: left ventricular mass index; CCI: Charlson Comorbidity Index; ACEIs/ARBs: angiotensin converting enzyme inhibitors/angiotensin receptor blockers; CCBs: calcium channel blockers; MRA: mineralocorticoid receptor antagonists; ARNI: angiotensin receptor-neprilysin inhibitor; SGLT-2i: sodium-glucose cotransporters-2 inhibitors; DPP-4i: dipeptidyl peptidase-4 inhibitors; GL-P1RAs: receptor agonists for glucagon-like peptide-1.

Figure 5. Multivariate logistic regression analysis of ALVDD in nondialysis CKD patients.

Figure 6. The ROC curve of the probability value predicted by the multivariate logistic regression model.

Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321–1360. doi: 10.1093/ehjci/jew082.

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