Introduction
Materials and methods
Population and study design
LVMI acquirement
Definition of LVMI changes and the grouping method
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Group 1: participants with LVMI-regression: ∆LVMI ≤ -5%LVMI0;
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Group 2: participants with LVMI stable: -5%LVMI0 < ∆LVMI < 5%LVMI0;
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Group 3: participants with LVMI-progression: ∆LVMI ≥ 5%LVMI0.
Clinical and laboratory data
End points
Statistical analysis
Results
Characteristics of study population
Baseline | 1st year | 2nd year | |
---|---|---|---|
Age | 54.3 ± 16.8 | / | / |
Male, n(%) | 130(60.2%) | / | / |
CAPD,n(%) | 202(93.5%) | / | / |
BMI (kg/m2) | 22.4 ± 3.3 | 23.3 ± 3.6* | 23.6 ± 3.8 |
SBP (mmHg) | 140(130,155) | 130(117,145) | 131(120,141) |
DBP (mmHg) | 80(73,90) | 80(70,90) | 80(72,90) |
MAP | 100.7(93.3,110.0) | 96.7(89.7,106.7)* | 98.0(90.0,106.7)* |
LVDd (cm) | 5.0(4.6,5.4) | 4.9(4.5,5.3)* | 4.9(4.4, 5.2)* |
PWT (cm) | 1.1(0.9,1.2) | 1.0(0.9,1.1)* | 1.0(0.9,1.2)* |
IVS (cm) | 1.1(1.0,1.3) | 1.1(1.0,1.3) | 1.1(1.0,1.3) |
LVMI (g/m2) | 128.9(107.7, 154.9) | 115.9(98.1,136.6)* | 116.6(93.3,139.6)* |
LVEF (%) | 66.0(62.0,71.0) | 67.0(64.0,71.0) | 67.0(63.0,72.0) |
E/A ratio | 0.79(0.63,1.00) | 0.73(0.61,0.90) | 0.71(0.59,0.87) |
Dialysis-related variables | |||
nPCR (g/kg/24 h) | 0.91 ± 0.19 | 0.95 ± 0.20 | 0.92 ± 0.22 |
Urinary output(L/24 h) | 1.10(0.63,1,50) | 0.80(0.40,1.33)* | 0.55(0.08,1.10)*# |
Total Ccr (L/week) | 78.4(62.4,96.7) | 64.9(52.5,80.2)* | 54.5(47.5,72.1)*# |
Residual renal Ccr (L/week) | 43.0(27.4,64.2) | 30.7(13.6,46.7)* | 17.1(0.83,38.2)* |
Total Kt/V | 2.04(1.76,2.42) | 1.86(1.62,2.14) | 1.79(1.58,2.08)* |
Residual renal Kt/V | 0.84(0.50,1.21) | 0.63(0.24,0.93)* | 0.33(0.01, 0.72)*# |
Volume of dialysate (per 1000 mL/24 h) | 5.98(5.51,6.37) | 6.21(5.75,7.89)* | 6.60(6.00,8.70)*# |
Proportion of 1.5%-glucose dialysate(%) | 100(100,100) | 70.8(66.7,100) | 100(66.7,100) |
Biochemical parameters | |||
Hemoglobin (g/L) | 86.7 ± 19.0 | 106.1 ± 16.7* | 107.0 ± 16.9* |
Ferritin (ng/ml) | 192.1(86.4,370.5) | 212.6(140.7,344.5) | 216.9(131.3,305.5) |
Serum iron (umol/L) | 10.3(7.7,14.1) | 12.6(9.9,17.4)* | 12.8(9.9,16.6)* |
Iron saturation (%) | 27.0(20.0,37.0) | 33.0(25.0, 43.0)* | 32.0(24.0,41.0)* |
Albumin (g/L) | 35.3 ± 5.1 | 35.9 ± 5.0 | 36.4 ± 4.8* |
Calcium (mmol/L) | 2.05(1.89, 2.19) | 2.18(2.05, 2.34)* | 2.24(2.09,2.37)* |
Phosphate (mmol/L) | 1.62(1.30,1.97) | 1.49(1.25,1.72)* | 1.49(1.24,1.79)* |
iPTH (pg/ml) | 270.5(158.4,440.0) | 261.2(156.5,408.6) | 255.5(164.0,389.5) |
CHO (mmol/L) | 4.13(3.54,5.11) | 4.24(3.65,4.93) | 4.18(3.61,5.02) |
TG (mmol/L) | 1.39(1.05,1.98) | 1.68(1.15,2.47)* | 1.72(1.15,2.56)* |
LDL (mmol/L) | 2.33(1.87,2.93) | 2.17(1.74,2.66)* | 2.19(1.72,2.71)* |
HDL (mmol/L) | 0.95(0.81,1.18) | 0.91(0.77,1.13) | 0.90(0.75,1.12)* |
ApoA1 (g/L) | 0.97(0.84,1.10) | 1.00(0.88,1.15)* | 0.99(0.87,1.17) |
ApoB (g/L) | 0.65(0.55,0.81) | 0.66(0.56,0.78) | 0.66(0.57.0.77) |
NT-proBNP (per 1000 pg/ml) | 1.81(0.83,6.45) | 1.31(0.57,3.08)* | 1.89(0.70,6.41)# |
hsCRP (mg/L) | 2.11(0.47,4.46) | 0.86(0.33,2.79)* | 0.85(0.41,2.67)* |
FIB (g/L) | 3.48(2.95,4.32) | 3.80(3.39,4.40)* | 3.82(3.32,4.45)* |
Total | LVMI-regression N = 113 | Stable N = 31 | LVMI-progression N = 72 | P value | |
---|---|---|---|---|---|
Age | 55.3 ± 16.8 | 54.2 ± 16.8 | 60.1 ± 16.4 | 55. 2 ± 17.0 | 0.785 |
Male, n(%) | 130(60.2%) | 65(57.5%) | 18(58.1%) | 42(64.6%) | 0.557 |
BMI (kg/m2) | 23.1 ± 3.5 | 22.6 ± 3.3 | 24.2 ± 3.1 | 23.7 ± 3.6 | 0.047 |
SBP (mmHg) | 135 ± 14 | 134 ± 14 | 135 ± 15 | 138 ± 15 | 0.124 |
DBP (mmHg) | 82 ± 8 | 81 ± 9 | 80 ± 8 | 84 ± 10 | 0.021 |
MAP | 99.6 ± 9.2 | 98.3 ± 8.8 | 98.7 ± 8.3 | 102.1 ± 9.7 | 0.018 |
History of smoking | 45(20.8%) | 23(20.4%) | 8(25.8%) | 13(20.0%) | 0.754 |
History of diabetes | 53(24.5%) | 29(25.7%) | 4(12.9%) | 20(30.8%) | 0.253 |
Use of statins | 42(19.4%) | 21(18.6%) | 6(19.4%) | 15(23.1%) | 0.931 |
Use of anti-hypertensive drugs | 200(92.6%) | 103(91.2%) | 28(90.3%) | 69(65.8%) | 0.436 |
Use of RAAS antagonists | 93(43.1%) | 51(45.1%) | 11(35.5%) | 30(46.2%) | 0.130 |
Dialysis-related variables | |||||
CAPD, n(%) | 202(93.5%) | 106(93.8%) | 27(87.1%) | 69(95.8%) | 0.251 |
nPCR (g/kg/24 h) | 0.93 ± 0.18 | 0.94 ± 0.17 | 0.91 ± 0.15 | 0.92 ± 0.18 | 0.647 |
Urinary output(L/24 h) | 0.86(0.50,1.28) | 0.83(0.46,1.28) | 0.83(0.67, 1.14) | 0.92(0.57,1.29) | 0.858 |
Total Ccr (L/week) | 67.5(57.1, 81.8) | 67.7(57.5,84.0) | 68.2(54.6, 88.7) | 66.8(57.4,79.5) | 0.733 |
Residual renal Ccr (L/week) | 31.3(18.9, 46.5) | 32.4(20.1,49.6) | 30.5(15.5,52.7) | 31.2(18.8,42.9) | 0.609 |
Total Kt/V | 1.93(1.72,2.22) | 1.94(1.71,2.26) | 1.98(1.70,2.16) | 1.88(1.73,2.15) | 0.539 |
Residual renal Kt/V | 0.61(0.36, 0.88) | 0.61(0.35,0.92) | 0.61(0.35,0.88) | 0.62(0.42,0.87) | 0.984 |
Proportion of 1.5%-glucose dialysate(%) | 88.9(69.4,100) | 88.9(67.8,100) | 80.6(66.7,100) | 91.7(75.0,100) | 0.770 |
Volume of dialysate(L/24 h) | 6.27(5.82, 7.59) | 6.19(5.83,7.53) | 6.40(5.92,7.44) | 6.30(5.73,7.68) | 0.917 |
Biochemical parameters | |||||
Hemoglobin (g/L) | 100.0 ± 13.8 | 101.8 ± 13.7 | 99.9 ± 13.7 | 96.6 ± 13.8 | 0.055 |
Ferritin (ng/ml) | 233.1(153.8, 327.3) | 256.0(163.7,343.2) | 207.1(157.0,267.7) | 205.8(138.7,307.3) | 0.033 |
Serum iron (umol/L) | 12.3(10.1, 15.1) | 13.3(10.6,15.3) | 12.1(10.4,14.5) | 11.6(9.2,14.3) | 0.129 |
Iron saturation (%) | 31.7(26.0, 38.0) | 32.7(27.3, 39.7) | 31.7(27.7, 36.0) | 28.3(24.0,34.3) | 0.059 |
Albumin (g/L) | 35.8 ± 4.4 | 36.3 ± 4.7 | 34.8 ± 4.2 | 35.3 ± 4.0 | 0.184 |
Calcium (mmol/L) | 2.15 ± 0.17 | 2.15 ± 0.18 | 2.16 ± 0.15 | 2.14 ± 0.14 | 0.812 |
Phosphate (mmol/L) | 1.53(1.32, 1.79) | 1.56 ± 0.32 | 1.55 ± 0.36 | 1.61 ± 0.40 | 0.513 |
iPTH (pg/mL) | 284.1(186.6, 393.7) | 302.3(203.7,423.3) | 208.5(156.4,332.3) | 283.8(180.8,388.4) | 0.139 |
CHO (mmol/L) | 4.40 ± 0.91 | 4.46 ± 0.99 | 4.22 ± 0.80 | 4.40 ± 0.83 | 0.439 |
TG (mmol/L) | 1.62(1.25, 2.28) | 1.64(1.23, 2.57) | 1.54(1.32, 2.33) | 1.64(1.22, 2.29) | 0.994 |
LDL (mmol/L) | 2.29(1.92, 2.71) | 2.25(1.88,2.73) | 2.29(1.74,2.59) | 2.32(2.08,2.70) | 0.311 |
HDL (mmol/L) | 0.94(0.80, 1.12) | 0.97(0.84,1.15) | 0.84(0.76,1.03) | 0.90(0.77,1.09) | 0.036 |
ApoA1 (g/L) | 0.99(0.89, 1.12) | 1.01(0.94, 1.15) | 0.93(0.86, 1.09) | 0.96(0.86, 1.06) | 0.009 |
ApoB (g/L) | 0.69 ± 0.15 | 0.69 ± 0.16 | 0.68 ± 0.14 | 0.70 ± 0.14 | 0.822 |
NT-proBNP (per 1000 pg/ml) | 2.26(0.93, 7.47) | 1.95(0.80,7.58) | 2.28(1.46,5.23) | 2.50(1.15,8.93) | 0.428 |
hsCRP (mg/L) | 1.65(0.79, 4.12) | 1.33(0.61,3.73) | 2.11(1.12,4.40) | 1.96(1.12,5.40) | 0.032 |
FIB (g/L) | 3.72(3.26, 4.31) | 3.64(3.13,4.13) | 3.85(3.34,4.36) | 3.88(3.45, 4.59) | 0.014 |
Association of LVMI changes with all-cause mortality and cardiovascular outcomes
All-cause mortality | Cardiovascular events | Cardiovascular mortality | |||||||
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HR | 95.0% CI | p | HR | 95.0% CI | p | HR | 95%CI | p | |
Age | 1.054 | 1.032–1.076 | < 0.001 | 1.037 | 1.017–1.057 | < 0.001 | 1.036 | 1.006–1.066 | 0.017 |
Sex | 0.792 | 0.445–1.412 | 0.430 | 0.546 | 0.300–0.914 | 0.048 | 0.657 | 0.268–1.612 | 0.359 |
History of diabetes | 2.547 | 1.451–4.470 | 0.001 | 2.684 | 1.556–4.629 | < 0.001 | 2.650 | 1.142–6.151 | 0.023 |
BMI (kg/m2) | 1.135 | 1.083–1.217 | < 0.001 | 1.119 | 1.032–1.214 | 0.006 | 1.069 | 0.945–1.209 | 0.287 |
MAP | 0.998 | 0.967–1.030 | 0.904 | 1.021 | 0.991–1.052 | 0.181 | 1.022 | 0.976–1.071 | 0.353 |
Use of statins | 1.263 | 0.553–2.882 | 0.579 | 1.639 | 0.875–3.069 | 0.123 | 1.978 | 0.773–5.509 | 0.155 |
Use of RAAS antagonists | 0.577 | 0.317–1.049 | 0.072 | 0.575 | 0.323–1.024 | 0.060 | 0.389 | 0.143–1.055 | 0.064 |
Use of anti-hypertensive drugs | 0.683 | 0.271–1.723 | 0.419 | 0.895 | 0.322–2.489 | 0.832 | 2.451 | 0.103–3.256 | 0.404 |
LVMI (g/m2) | 1.010 | 1.001–1.020 | 0.027 | 1.017 | 1.008–1.025 | < 0.001 | 1.012 | 0.999–1.026 | 0.073 |
LVMI -progression | 1.417 | 1.049–1.915 | 0.023 | 1.359 | 1.015–1.820 | 0.039 | 1.475 | 0.935–2.326 | 0.095 |
Hemoglobin (g/L) | 0.990 | 0.970–1.010 | 0.319 | 0.996 | 0.977–1.016 | 0.717 | 1.005 | 0.974–1.038 | 0.735 |
Albumin (g/L) | 0.954 | 0.890–1.023 | 0.187 | 1.011 | 0.940–1.088 | 0.761 | 1.046 | 0.938–1.165 | 0.418 |
CHO (mmol/L) | 1.028 | 0.748–1.412 | 0.866 | 0.971 | 0.705–1.337 | 0.857 | 1.022 | 0.637–1.640 | 0.928 |
LDL (mmol/L) | 1.239 | 0.820–1.874 | 0.309 | 1.187 | 0.790–1.783 | 0.408 | 1.243 | 0.676–2.286 | 0.484 |
TG (mmol/L) | 0.883 | 0.659–1.182 | 0.403 | 0.977 | 0.759–1.257 | 0.856 | 0.531 | 0.273–1.036 | 0.063 |
HDL (mmol/L) | 1.157 | 0.438–3.057 | 0.768 | 0.354 | 0.115–1.091 | 0.071 | 1.867 | 0.481–7.244 | 0.367 |
ApoA (g/L) | 1.262 | 1.108–1.437 | < 0.001 | 1.127 | 1.103–1.463 | 0.001 | 1.315 | 1.140–1.517 | < 0.001 |
ApoB (g/L) | 2.495 | 0.411–3.309 | 0.772 | 1.953 | 0.293–12.992 | 0.489 | 0.682 | 0.109–29.868 | 0.682 |
hsCRP (mg/L) | 1.001 | 0.967–1.037 | 0.936 | 1.018 | 0.992–1.044 | 0.178 | 1.004 | 0.955–1.055 | 0.884 |
nPCR (g/kg/24 h) | 0.040 | 0.006–0.256 | 0.001 | 0.107 | 0.017–0.653 | 0.016 | 0.222 | 0.016–3.123 | 0.265 |
Urinary output(L/24 h) | 0.542 | 0.309–0.952 | 0.033 | 0.856 | 0.499–1.467 | 0.571 | 0.771 | 0.325–1.830 | 0.556 |
Total Ccr (L/week) | 0.997 | 0.985–1.009 | 0.646 | 0.998 | 0.987–1.010 | 0.786 | 1.001 | 0.984–1.019 | 0.880 |
Residual renal Ccr (L/week) | 0.997 | 0.986–1.008 | 0.575 | 0.998 | 0.987–1.008 | 0.650 | 0.999 | 0.989–1.009 | 0.872 |
Total Kt/V | 1.075 | 0.931–1.241 | 0.326 | 1.081 | 0.931–1.254 | 0.305 | 1.148 | 0.997–1.323 | 0.055 |
Residual renal Kt/V | 0.814 | 0.438–1.511 | 0.514 | 0.834 | 0.460–1.511 | 0.549 | 0.995 | 0.403–2.459 | 0.992 |
Proportion of 1.5%-glucose dialysate(%) | 1.452 | 0.263–8.014 | 0.669 | 1.057 | 0.172–6.479 | 0.952 | 2.080 | 0.178–24.236 | 0.559 |
Volume of dialysate (per1000mL/24 h) | 1.319 | 1.096–1.586 | 0.003 | 1.294 | 1.075–1.557 | 0.006 | 1.193 | 0.898–1.583 | 0.223 |
All-cause mortality | Cardiovascular events | Cardiovascular mortality | ||||
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HR (95%CI) | P-value | HR (95%CI) | P-value | HR (95%CI) | P-value | |
Model 1 | 1.417(1.049–1.915) | 0.023 | 1.359(1.015–1.820) | 0.039 | 1.475(0.935–2.326) | 0.095 |
Model 2 | 1.405(1.035–1.905) | 0.029 | 1.0381(1.018–1.059) | 0.047 | 1.438(0.905–2.285) | 0.124 |
Model 3 | 1.424(1.042–1.947) | 0.027 | 1.391(1.012–1.912) | 0.042 | 1.643(1.020–2.645) | 0.042 |
Model 4 | 1.419(1.016–1.982) | 0.040 | 1.494(1.063–2.099) | 0.021 | 1.836(1.084–3.108) | 0.024 |
Risk factors for LVMI-progression
Univariate | Multivariate | |||
---|---|---|---|---|
OR (95%CI) | P-value | OR (95%CI) | P-value | |
Age | 1.000 (0.982–1.017) | 0.974 | - | - |
Sex | 0.765(0.419–1.397) | 0.383 | - | - |
BMI (kg/m2) | 1.085(0.995–1.182) | 0.064 | - | - |
MAP | 1.061(1.025–1.099) | 0.001 | 1.074(1.029–1.121) | 0.001 |
Use of anti-hypertensive drugs | 3.219(0.710–14.591) | 0.129 | - | - |
Hemoglobin (g/L) | 0.974(0.953–0.995) | 0.017 | 0.970(0.942–0.998) | 0.037 |
Ferritin (ng/ml) | 0.998(0.995–1.000) | 0.071 | 0.995(0.992–0.999) | 0.006 |
ApoA1(g/L) | 0.051(0.006–0.402) | 0.005 | - | - |
hsCRP (mg/L) | 1.043(1.003–1.085) | 0.036 | - | - |
Fib (g/L) | 1.745(1.241–2.453) | 0.001 | 1.800(1.181–2.745) | 0.006 |
NT-proBNP (per 1000 pg/ml) | 1.032(0.989–1.076) | 0.147 | - | - |
Proportion of 1.5%-glucose dialysate(%) | 0.852(0.132–5.507) | 0.866 | - | - |