Predictive value of indicators for left ventricular systolic dysfunction in HD patients

Abstract

Background: To evaluate the role of dialysis duration, creatine, cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) for predicting left ventricular systolic dysfunction (LVSD) in hemodialysis (HD) patients. Methods: Participants with regular hemodialysis for more than three months between January 2017 and January 2022 were enrolled. Correlation analysis was used to assess the correlations among the clinical, serological and echocardiographic variables. The risk factors of LVSD were discussed by univariate and multivariate logistic regression analysis. Receiver-operating characteristic curve (ROC) was constructed to evaluate their predictive value.Results: The 237 HD patients were divided into two groups, NT-pro-BNP > 35000 pg/ml vs. NT-pro-BNP ≤ 35000 pg/ml. In HD patients with NT-pro-BNP ≤ 35000 pg/ml group, cTnT (r = -0.222, P = 0.011) and NT-pro-BNP (r = -0.248, P = 0.002) were significantly correlated with EF. Factors associated with LVSD and corresponding odds ratios (ORs) with 95% CI by multivariate analysis were dialysis duration [0.158 (0.036, 0.689), P ＝ 0.010], creatine [0.255 (0.078, 0.833), P ＝ 0.020] and cTnT [10.858 (2.278, 51.758), P ＝ 0.000] in HD patients with NT-pro-BNP > 35000 pg/ml. In HD patients with NT-pro-BNP ≤ 35000 pg/ml, dialysis duration [0.266 (0.075, 0.938), P ＝ 0.034] and NT-pro-BNP [11.132 (2.904, 42.679), P ＝ 0.000] were both independent risk factors of LVSD in multivariate analysis. In HD patients with NT-pro-BNP > 35000 pg/ml group, the combination of dialysis duration and creatinine [(area under the curve (AUC): 0.664); P ＝ 0.002], dialysis duration and cTnT (AUC: 0.690 ; P ＝ 0.000), creatinine and cTnT (AUC: 0.702; P ＝ 0.000) and dialysis duration, creatinine and cTnT (AUC: 0.753; P ＝ 0.000) had the significantly statistic value to predict LVSD; In HD patients with NT-pro-BNP ≤ 35000 pg/ml group, the combination of dialysis duration and NT-pro-BNP had the best diagnostic value (AUC: 0.802; sensitivity: 89.55%; P < 0.000). Conclusion: Our results implicated that the combination of dialysis duration, creatine cTnT and NT-pro-BNP might be used for early prediction and management of LVSD in HD patients.