| Objective To explore the influencing factors of symptoms of heart failure with preserved ejection fraction in maintenance hemodialysis(MHD) patients. Methods The clinical data of MHD patients at the 901st hospital of Joint Logistic Support Force of the Chinese PLA from January 2020 to December 2022 were retrospectively analyzed. A total of 45 patients with symptoms of HFpEF were selected as the HFpEF group, while 45 patients without heart failure symptoms during the same period were selected as the non-HFpEF group. Demographic data, laboratory data, cardiac ultrasound data, pre-dialysis body mass growth rate and blood pressure between the two groups were compared.Binary logistic regression was used to assess the risk factors for symptoms of HFpEF in MHD patients. Predictive accuracy of NT-proBNP for symptoms of HFpEF in MHD patients was assessed by calculating the area under curve(AUC) by receiver operating characteristic(ROC) analysis. Results Statistical analysis of NT-proBNP converted into Ln NT-proBNP by natural log transformed. Univariate analysis showed that the age was older, and the proportion of diabetes history, the level of serum intact parathyroid hormone(iPTH), the level of Ln NT-proBNP, the left atrial diameter and the body mass growth rate were higher in the HFpEF group than in the non-HFpEF group(P<0.05). The level of hemoglobin and the rates of ARB use in the HFpEF group were lower than those in the non-HFpEF group(P<0.05). Binary logisitc regression analysis showed that Ln NT-proBNP and body mass growth rate were independent risk factors for HFpEF symptoms in MHD patients(P<0.05), while use of ARB drugs was independent protective factor(P<0.05). ROC curve analysis showed that the AUC of NT-proBNP predicting symptoms of HFpEF in overall MHD patients was 0.776(95% CI:0.678~0.873). The optimal cutoff value for NT-proBNP was 2 326.5pg/mL, the sensitivity was 84.4%, and the specificity was 64.4%. The AUC of NT proBNP for predicting HFpEF symptoms in MHD patients ≤ 50 years, 50~75 years,and ≥ 75 years were 0.817(95% CI:0.640~0.993), 0.825(95% CI:0.702~0.948), and 0.795(95% CI:0.585~1.000), respectively. The optimal cutoff values were 2 326.5 pg/mL,2 734.0 pg/mL and 4 506.5 pg/mL respectively. The sensitivity was 87.5%,69.2% and 81.8% respectively.The specificity was 66.7%, 90.9% and 75.0% respectively. Conclusions Controlling the growth of body mass during interdialytic and using ARB drugs can reduce the risk of symptoms of HFpEF in MHD patients.Meanwhile, NT-proBNP levels stratified by age have a certain predictive effect on the occurrence of HFpEF symptoms in MHD patients. |
