Background
Methods
Participants
Clinical and laboratory data collection
Data analysis
Results
All | CKD1 | CKD2 | CKD3 | CKD4 | CKD5 | |
---|---|---|---|---|---|---|
No. of patients | 705 | 84 | 63 | 108 | 132 | 318 |
Age (years) | 48.12 ± 15.02 | 39.50 ± 15.59 | 45.49 ± 15.10 | 49.52 ± 15.15 | 51.54 ± 15.30 | 46.44 ± 14.63 |
Gender | ||||||
Male, n (%) | 390 (55.32%) | 44 (52.38%) | 25 (39.68%) | 75 (69.44%) | 85 (64.39%) | 161 (52.83%) |
Female, n (%) | 315 (44.68%) | 40 (47.62%) | 38 (60.32%) | 33 (30.56%) | 47 (35.61%) | 157 (47.17%) |
BMI (kg/m2) | 22.32 ± 4.45 | 21.88 ± 4.08 | 22.43 ± 4.58 | 22.04 ± 4.56 | 22.19 ± 3.88 | 22.56 ± 4.70 |
Etiology of CKD, n (%) | ||||||
Glomerulonephritis | 481 (68.23%) | 65 (77.38%) | 39 (61.90%) | 79 (73.15%) | 83 (62.88%) | 215 (67.61%) |
Diabetic nephropathy | 104 (14.75%) | 9 (10.71%) | 13 (20.63%) | 12 (11.11%) | 25 (18.94%) | 45 (14.15%) |
Hypertensive nephropathy | 57 (8.09%) | 4 (4.76%) | 6 (9.52%) | 9 (8.33%) | 13 (9.85%) | 25 (7.86%) |
Lupus nephritis | 14 (1.99%) | 0 (0%) | 1 (1.59%) | 1 (0.93%) | 5 (3.79%) | 7 (2.20%) |
Polycystic kidney disease | 20 (2.84%) | 3 (3.57%) | 1 (1.59%) | 3 (2.78%) | 1 (0.76%) | 12 (3.77%) |
Others | 29 (4.11%) | 3 (3.57%) | 3 (4.76%) | 4 (3.70%) | 5 (3.79%) | 14 (4.40%) |
Medications, n (%) | ||||||
ACEI or ARB | 294 (41.70%) | 49 (58.33%) | 16 (25.40%) | 0 (0%) | 51 (38.64%) | 178 (55.97%) |
Diuretics | 88 (12.48%) | 0 (0%) | 0 (0%) | 28 (25.93%) | 24 (18.18%) | 36 (11.32%) |
CCB | 407 (57.73%) | 21 (25%) | 21 (25%) | 64 (59.26%) | 92 (69.70%) | 209 (65.72%) |
β-blocker | 285 (40.43%) | 13 (15.48%) | 16 (25.40%) | 43 (39.81%) | 64 (48.48%) | 149 (46.86%) |
α-blocker | 18 (2.55%) | 0 (0%) | 0 (0%) | 2 (1.85%) | 5 (3.79%) | 11 (3.46%) |
Digoxin | 14 (1.99%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 14 (4.40%) |
Warfarin | 26 (3.69%) | 0 (0%) | 0 (0%) | 12 (11.11%) | 0 (0%) | 14 (4.40%) |
Prostacyclin | 247 (35.04%) | 0 (0%) | 12 (19.05%) | 76 (70.37%) | 82 (62.12%) | 77 (24.21%) |
Laboratory tests | ||||||
Hb (g/L) | 94.19 ± 23.46 | 103.66 ± 20.54 | 100.68 ± 21.29 | 103.05 ± 26.33 | 94.64 ± 23.56 | 87.22 ± 21.26 |
ALB (g/L) | 34.75 ± 5.68 | 35.60 ± 5.07 | 34.39 ± 5.26 | 34.80 ± 5.59 | 34.27 ± 5.25 | 34.78 ± 6.11 |
TC (mmol/L) | 4.37 ± 1.16 | 4.41 ± 0.98 | 4.50 ± 1.28 | 4.44 ± 1.30 | 4.12 ± 0.93 | 4.41 ± 1.21 |
TG (mmol/L) | 1.68 ± 1.10 | 1.52 ± 0.82 | 1.53 ± 0.80 | 1.66 ± 1.03 | 1.82 ± 1.26 | 1.70 ± 1.17 |
Proteinuria (mg/24 h) | 1783.13 ± 1233.31 | 1387.64 ± 1016.40 | 1586.44 ± 1122.68 | 1543.20 ± 1207.24 | 1699.50 ± 1158.92 | 2042.75 ± 1294.12 |
Ca (mmol/L) | 2.17 ± 0.19 | 2.20 ± 0.11 | 2.16 ± 0.11 | 2.27 ± 0.12 | 2.22 ± 0.14 | 2.22 ± 0.24 |
P (mmol/L) | 1.41 ± 0.52 | 0.99 ± 0.12 | 1.04 ± 0.13 | 1.11 ± 0.13 | 1.25 ± 0.23 | 1.76 ± 0.57 |
PTH (pg/ml) | 326.20 ± 180.71 | 271.98 ± 123.31 | 334.10 ± 182.36 | 290.55 ± 153.09 | 320.75 ± 146.67 | 353.33 ± 207.99 |
Ferritin (ng/ml) | 350.27 ± 192.52 | 319.08 ± 95.40 | 331.24 ± 92.25 | 366.82 ± 258.77 | 354.95 ± 132.96 | 354.72 ± 218.88 |
SI (μmol/L) | 12.38 ± 5.62 | 12.74 ± 4.88 | 12.36 ± 5.62 | 12.49 ± 5.36 | 11.60 ± 5.69 | 12.58 ± 5.86 |
C3 (g/L) | 0.96 ± 0.29 | 1.01 ± 0.32 | 0.96 ± 0.29 | 0.98 ± 0.31 | 0.93 ± 0.31 | 0.94 ± 0.27 |
Hemodynamics | ||||||
SBP (mmHg) | 141.24 ± 14.14 | 137.43 ± 12.18 | 138.30 ± 9.89 | 138.45 ± 16.09 | 142.33 ± 14.78 | 143.32 ± 13.97 |
DBP (mmHg) | 85.44 ± 9.80 | 82.41 ± 9.21 | 84.48 ± 8.34 | 84.43 ± 10.35 | 84.28 ± 10.08 | 87.26 ± 9.62 |
PASP (mmHg) | 39.39 ± 13.86 | 32.40 ± 9.35 | 38.38 ± 14.66 | 38.04 ± 13.69 | 38.86 ± 13.78 | 42.13 ± 14.09 |
LVEF (%) | 62.05 ± 10.04 | 65.08 ± 10.02 | 64.81 ± 6.49 | 63.92 ± 8.46 | 61.45 ± 9.88 | 60.31 ± 10.79 |
Epidemiology of PH in different stages of CKD
Determinants of PH in CKD patients
All | PASP ≤35 mmHg | 35 mmHg < PASP ≤45 mmHg | 45 mmHg < PASP ≤60 mmHg | PASP > 60 mmHg | |
---|---|---|---|---|---|
No. of patients | 705 | 371 | 156 | 106 | 72 |
Age (years) | 48.12 ± 15.02 | 48.43 ± 15.50 | 45.50 ± 14.08 | 49.83 ± 15.81 | 49.71 ± 12.63 |
Gender | |||||
Male, n (%) | 400 | 231 (57.75%) | 73 (18.25%) | 46 (11.50%) | 40 (10.00%) |
Female, n (%) | 305 | 140 (45.90%) | 83 (27.21%)a | 60 (19.67%)a | 32 (10.49%) |
BMI (kg/m2) | 22.32 ± 4.45 | 21.55 ± 3.96 | 22.98 ± 4.94** | 22.47 ± 4.39 | 24.65 ± 4.85*** |
Etiology of CKD, n (%) | |||||
Glomerulonephritis | 481 | 268 (55.72%) | 100 (20.79%) | 69 (14.35%) | 44 (9.15%) |
Diabetic nephropathy | 104 | 45 (43.27%) | 31 (29.81%)b | 17 (16.35%) | 11 (10.58%) |
Hypertensive nephropathy | 57 | 30 (52.36%) | 13 (22.81%) | 9 (15.79%) | 5 (8.77%) |
Lupus nephritis | 14 | 4 (28.57%) | 0 (0%) | 3 (21.43%) | 7 (50.00%)b |
Polycystic kidney disease | 20 | 11 (55.00%) | 6 (30.00%) | 3 (15.00%) | 0 (0%) |
Others | 29 | 13 (44.83%) | 6 (20.69%) | 5 (17.24%) | 5 (17.24%) |
No. of anti-hypertensives | |||||
0 anti-hypertensive | 72 | 41 (56.94%) | 14 (19.44%) | 9 (12.50%) | 8 (11.11%) |
1 anti-hypertensives | 180 | 107 (59.44%) | 28 (15.56%) | 29 (16.11%) | 16 (8.89%) |
2 anti-hypertensives | 230 | 132 (57.39%) | 56 (24.35%) | 22 (9.57%) | 20 (8.70%) |
3 anti-hypertensives | 155 | 63 (40.65%) | 39 (25.16%) | 37 (23.87%) | 16 (10.32%) |
≥ 4 anti-hypertensives | 68 | 28 (41.18%) | 19 (27.94%) | 9 (13.24%) | 12 (17.65%) |
Other medications, n (%) | |||||
Digoxin | 14 | 5 (35.71%) | 0 (0%) | 5 (35.71%) | 4 (28.57%) |
Warfarin | 26 | 5 (19.23%) | 12 (46.15%) | 5 (19.23%) | 4 (15.38%) |
Prostacyclins | 247 | 120 (48.58%) | 55 (22.27%) | 37 (14.98%) | 35 (14.17%) |
Laboratory tests | |||||
Hb (g/L) | 94.19 ± 23.46 | 107.45 ± 19.82 | 80.37 ± 19.50*** | 77.91 ± 19.40*** | 81.37 ± 12.77*** |
ALB (g/L) | 34.75 ± 5.68 | 35.44 ± 5.11 | 34.50 ± 5.98 | 33.15 ± 6.92* | 34.06 ± 5.31 |
TC (mmol/L) | 4.37 ± 1.16 | 4.28 ± 0.99 | 4.43 ± 1.58 | 4.57 ± 1.10 | 4.38 ± 0.93 |
TG (mmol/L) | 1.68 ± 1.10 | 1.52 ± 0.81 | 1.90 ± 1.50* | 1.61 ± 0.95 | 2.13 ± 1.43** |
Proteinuria (mg/24 h) | 1783.13 ± 1233.31 | 1176.14 ± 971.05 | 2132.18 ± 1051.07*** | 2737.32 ± 1372.09*** | 2749.72 ± 687.34*** |
Ca (mmol/L) | 2.17 ± 0.19 | 2.18 ± 0.18 | 2.17 ± 0.20 | 2.14 ± 0.20 | 2.21 ± 0.20 |
P (mmol/L) | 1.41 ± 0.52 | 1.31 ± 0.46 | 1.51 ± 0.53*** | 1.57 ± 0.62*** | 1.43 ± 0.55 |
PTH (pg/ml) | 326.20 ± 180.71 | 266.02 ± 148.51 | 358.54 ± 163.65*** | 353.40 ± 154.59*** | 526.15 ± 228.42*** |
Ferritin (ng/ml) | 350.27 ± 192.52 | 354.34 ± 224.21 | 301.23 ± 142.90** | 370.56 ± 146.29 | 405.68 ± 142.19 |
SI (μmol/L) | 12.38 ± 5.62 | 12.46 ± 5.81 | 13.05 ± 6.51 | 11.50 ± 4.60 | 11.83 ± 3.35 |
C3 (g/L) | 0.96 ± 0.29 | 1.01 ± 0.33 | 0.92 ± 0.26** | 0.84 ± 0.22*** | 0.95 ± 0.21 |
Hemodynamics | |||||
SBP (mmHg) | 141.24 ± 14.14 | 138.46 ± 13.19 | 143.71 ± 16.22** | 145.53 ± 14.98*** | 143.89 ± 9.00*** |
DBP (mmHg) | 85.44 ± 9.80 | 83.59 ± 9.45 | 87.28 ± 10.89** | 88.49 ± 10.08*** | 86.54 ± 6.08** |
eGFR (ml/min/1.73m2) | 33.55 ± 32.51 | 43.71 ± 36.13 | 22.84 ± 25.27*** | 18.48 ± 15.57*** | 26.57 ± 27.29*** |
LVEF (%) | 62.05 ± 10.04 | 63.50 ± 9.33 | 66.13 ± 7.19** | 56.23 ± 11.05*** | 54.26 ± 9.66*** |
No. of dialysis patients (%) | 331 | 136 (36.66%) | 81 (51.92%) | 66 (62.26%) | 48 (66.67%) |
Time of dialysis (months) | 16.89 ± 14.16 | 16.58 ± 14.01 | 15.54 ± 11.42*** | 16.48 ± 14.46*** | 20.29 ± 17.64*** |
Determinants | OR (95%CI) | P-value |
---|---|---|
Gender | 0.874 (0.541–1.412) | 0.581 |
BMI (kg/m2) | 1.070 (1.011–1.133) | 0.020 |
Glomerulonephritis | reference | |
Diabetic nephropathy | 0.926 (0.299–2.869) | 0.894 |
Hypertensive nephropathy | 1.589 (0.451–5.597) | 0.471 |
Lupus nephritis | 0.542 (0.141–2.078) | 0.372 |
Polycystic kidney disease | 1.335 (0.137–13.056) | 0.804 |
Others | 0.753 (0.128–4.438) | 0.754 |
Hb (g/L) | 0.942 (0.929–0.954) | 0.000 |
ALB (g/L) | 1.017 (0.977–1.059) | 0.411 |
TG (mmol/L) | 1.445 (1.147–1.822) | 0.002 |
Proteinuria (mg/24 h) | 1.001 (1.001–1.001) | 0.000 |
P (mmol/L) | 0.826 (0.488–1.397) | 0.475 |
PTH (pg/ml) | 1.004 (1.002–1.005) | 0.000 |
C3 (g/L) | 0.496 (0.172–1.012) | 0.064 |
SBP (mmHg) | 1.003 (0.982–1.024) | 0.785 |
DBP (mmHg) | 1.021 (0.990–1.053) | 0.180 |
eGFR (ml/min/1.73m2) | 0.981 (0.971–0.990) | 0.000 |
LVEF (%) | 0.987 (0.962–1.012) | 0.302 |
Time of dialysis (months) | 0.979 (0.957–1.001) | 0.060 |