Prevalence and correlation factors of cardiovascular damage in patients with diabetic nephropathy and non-diabetic nephropathy

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Objective To investigate the prevalence and correlation factors of cardiovascular damage in patients with diabetic nephropathy (DN) and non-diabetic nephropathy (NDN). Methods A total of 278 chronic kidney disease (CKD) patients admitted to the First Affiliated Hospital of Jinan University from January 2014 to May 2016 were enrolled, including 78 case of DN and 200 case of NDN. Patients had cardiac and carotid ultrasonography test by colour doppler ultrasonography, and their clinical and biochemical data were collected. Multiple linear regression analysis and multivariable logistic regression analysis were applied to study the correlation factors of cardiovascular damage in CKD patients. Results Mean age was 48.22 years in the 278-patient cohort, which included 178(64.03%) men. Compared with NDN group, DN patients had higher left atrial dimension, interventricular septal thickness, left ventricular end-diastolic dimension, left ventricular posterior wall thickness, left ventricular mass index (LVMI), carotid intima-media thickness (cIMT) and carotid plaques ratio. Their estimated glomerular filtration rate (eGFR) and the ratio between the peak speed of the early filling wave and that of the atrial contraction wave (E/A ratio) were however lower (all P<0.05). Prevalence of left ventricular hypertrophy (LVH), left ventricular relaxant function reduction and cIMT thickening in DN group were 67.95%, 70.27% and 57.14%, higher than those in NDN group (40.00%, 42.31% and 17.39%, respectively) (all P<0.05). Along with the progress of CKD, LVMI and LVH proportion in patients with DN and NDN increased gradually. LVMI and LVH proportion in DN patients in CKD 1-2 phase and CKD 3-4 phase were higher than those in NDN patients (all P<0.05). In all CKD phases, cIMT and cIMT thickening proportion in DN group were higher than those in NDN group (all P<0.05). Just in CKD 1-2 phase, DN group had lower E/A ratio and higher proportion of left ventricular relaxant function reduction than NDN group (all P<0.05). After multiple linear regression analysis, gender, BMI, hemoglobin, eGFR and DN were related with LVMI; age, serum calcium and DN were related with E/A ratio; age and DN were related with cIMT (all P<0.05). In multivariate logistic regression, DN, hemoglobin and eGFR decrease were independently associated with LVH; age and BMI were independently associated with reduction of left ventricular relaxant function; age and DN were independently associated with cIMT thickening in all CKD patients (all P<0.05). Conclusions DN patients have more severe cardiovascular damage than NDN patients, and DN may be associated with LVMI, E/A ratio, cIMT, LVH and cIMT thickening in all CKD patients. Key words: Diabetic nephropathies; Cardiovascular diseases; Hypertrophy, left ventricular; Carotid intima-media thickening