Correlation between pulmonary arterial hypertension and nutritional status in maintenance hemodialysis patients

Abstract

Objective To analysis the impact of malnutrition for the development of pulmonary hypertension in maintenance hemodialysis(MHD) patients. Methods Ninety-four cases MHD patients who were treated in the First Affiliated Hospital of Hunan Normal University from March 2016 to June 2016 were enrolled.Subjective global assessment(SGA), anthropometric measurements and biochemical parameters were used to assess nutritional status.Systolic pulmonary arterial pressure(SPAP) and parameters relating to cardiac structure and function of MHD patients were assessed by echocardiography detection.The patients were assigned into the pulmonary hypertension(PH) group with 30 cases and the no PH group with 64 cases.Laboratory and clinical data were compared between the two groups. Results (1)Ninety-four cases MHD patients with 31.91%(n=30) pulmonary hypertension, 41.45%(n=39) malnutrition.(2)Light-moderate malnutrition and severe malnutrition accounted for 60.00%(18/30), 3.33%(1/30) respectively in PH group, 29.23%(19/64), 1.54%(1/64) respectively in nPH group, the differences were significant(Z=-2.911, P=0.004). (3)Compared with nPH group, the nutrition-related indicators in PH group: SGA score was significantly higher((18.87±4.45) points vs.(12.58±3.48) points, t=-6.827, P<0.001), the levels of Alb was significantly lower((33.56±2.27) g/L vs.(38.11±3.73) g/L, t=7.280, P<0.001), the levels of Hb was significantly lower((89.77±12.62) g/L vs.(101.61±17.30) g/L, t=3.749, P<0.001), BMI was significantly lower(19.18 ± 2.34) kg/m2 vs.(21.72±3.36) kg/m2, t=2.031, P=0.039), TSF value was significantly lower((12.98±3.69) mm vs.(15.61±5.66) mm, t=3.858, P=0.009), mid-arm muscle circumference(MAMC) value was significantly lower((19.18±2.67) cm vs.(21.83±3.62) cm, t=2.797, P=0.039). (4)In MHD patients, pulmonary arterial pressure was negative correlation with TSF(r=-0.279, P=0.007), MAC(r=-0.359, P<0.001), MAMC(r=-0.234, P=0.023), BMI (r=-0.214, P=0.021), Alb(r=-0.676, P<0.001), Hb(r=-0.360, P<0.001), LVEF(r=-0.491, P<0.001), positive correlation with SGA scores(r=0.725, P<0.001), left ventricular mass index(LVMI)(r=0.570, P<0.001), IGWG(r=0.342, P=0.001). (5)Logistic regression found that Alb(OR=0.064, 95%CI 0.014-0.292, P<0.001), Hb(OR=0.132, 95%CI 0.031-0.565, P=0.006), TSF(OR=0.128, 95%CI 0.027-0.606, P=0.010), LVMI(OR=13.157, 95%CI 2.615-66.193, P=0.002) were the major factors for PH. Conclusion The nutritional status is negative correlation with pulmonary artery pressure, malnutrition is the one of independent risk factor for pulmonary hypertension. Key words: Maintenance hemodialysis; Pulmonary hypertension; Malnutrition