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Abstract: PUB159

Secondary Hyperparathyroidism Is Independently Associated with Left Ventricular Diastolic Dysfunction in Patients with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Kim, Il Young, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Park, In seong, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Kim, Min Jeong, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Han, Miyeun, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Rhee, Harin, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Song, Sang Heon, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Seong, Eun Young, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Lee, Dong Won, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Lee, Soo Bong, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Kwak, Ihm Soo, Pusan National University Hospital, Busan, Korea (the Republic of)
Background

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Left ventricular diastolic dysfunction is known for the predictor of CVD in these patients. Secondary hyperparathyroidism (SHPT), a common complication of CKD, contribute to cardiac dysfunction. This study aimed to evaluate the association between SHPT and left ventricular diastolic dysfunction in patients with CKD.

Methods

This study included 332 pre-dialysis CKD patients (estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2). Two-dimensional echocardiography was performed to left ventricular ejection fraction (LVEF). Tissue Doppler imaging was used to measure the early mitral inflow velocity (E) and the peak early mitral annular velocity (E'). Diastolic function was estimated by the E' and the ratio of E to E' (E/E'). The associations of echocardiographic index with clinical and laboratory variables [age, sex, diabetes, hypertension, eGFR, albumin, uric acid, calcium, phosphate, total cholesterol, hemoglobin, C-reactive protein, and intact parathyroid hormone (PTH)] were investigated by univariate (Pearson’s correlation, r) and multivariate analysis (multiple linear regression analysis, β).

Results

Of the 332 patients, 198 were in CKD stage 3, 84 in CKD stage 4, and 50 in CKD stage 5. The degree of diastolic dysfunction was more severe (lower E' and higher E/E') with increasing CKD stage. There were no significant differences between the three CKD groups in LVEF. In univariate analysis, the intact PTH levels correlated with E' (r = -0.321, P < 0.001) and E/E' (r = 0.297, P < 0.001). However, they did not correlated with index of systolic dysfunction (LVEF). In multivariate analysis, the intact PTH levels were significantly associated with E' (β = -0.349, P < 0.001), and E/E' (β = 0.322, P < 0.001) after adjustment for other confounding factors.

Conclusion

Increased intact PTH levels were independently associated with decreased E' and increased E/E' in patients with CKD, suggesting that SHPT are independent predictor of left ventricular diastolic dysfunction in these patients. Further studies are needed to determine whether the treatment for SHPT could prevent left ventricular diastolic dysfunction in CKD patients.