Analysis Of Coronary Artery Calcification And Related Factors In Patients With Maintenance Hemodialysis

Backgroud:Cardiovascular disease(CVD)is one of the most common causes of death in patients with maintenance hemodialysis(MHD),and coronary artery calcification(CAC)is the most common pathological manifestation of CVD.CAC in MHD patients is characterized by high incidence,rapid progress and high calcification score.Studying risk factors and pathogenesis of CAC in MHD patients is the key to the early prevention of CAC,and is significant for the prevention of CAC in MHD patients,as well as the reduction of mortality.Objective:To explore the risk factors for the occurrence and development of coronary artery calcification(CAC)in MHD patients,especially the correlation with uremic pruritus(UP),so as to provide new ideas for the clinical prevention and treatment of CAC and UP in MHD patients.Methods:A total of 91 MHD patients receiving hemodialysis in the blood purification center of Yixing people’s hospital from January 2018 to December 2018 were selected.Basic clinical data of the patients,including gender,age,primary disease,dialysis duration,smoking history and blood pressure were collected.Laboratory parameters including hemoglobin(Hb),serum albumin(ALB),triglycerides(TG),total cholesterol(TC),high-density lipoprotein(HDL),low density lipoprotein(LDL)blood,blood calcium(Ca),phosphorus(P),intact parathyroid hormone(iPTH),alkaline phosphatase(AKP),white blood cells(WBC),neutrophil lymphocyte ratio(NLR),hypersensitive c-reactive protein(hsCRP),ferritin were measured.Imaging examination including color doppler ultrasound and dual source CT.Coronary artery calcification scores(CACs)were analyzed by the same senior radiologist using Agatston method,and visual analogue score(VAS)was used by the same senior dermatologist to evaluate pruritus.Univariate analysis of CAC related factors was conducted for the above indicators,and independent risk factors of CAC were further analyzed by Logistic regression.Results:1.The incidence of CAC in MHD patients was 69.3%,among which 59.4%were moderate-severe calcification,the highest incidence of CAC in hypertensive nephropathy(100%),and the second highest incidence of CAC in diabetic nephropathy(76.2%).The incidence of UP was 74.8%,mainly with mild to moderate extent.The incidence of UP in hypertensive nephropathy was the highest(93.3%),and the incidence of UP in diabetic nephropathy was the second(71.4%).2.Smoking history,the scores of age,dialysis duration,blood calcium,iPTH,AKP and pruritus,left ventricle hypertrophy,in the calcification group were higher than those in the non-calcification group,while high-density lipoprotein were lower than those in the non-calcification group(P<0.05).Systolic blood pressure,diastolic blood pressure,hemoglobin,serum albumin,blood phosphorus,triglycerides,total cholesterol,low-density lipoprotein,white blood cell,NLR,hsCRP,ferritin in the calcification group were compared with those in the non-calcification group,and the differences were not statistically significant.3.Logistic regression analysis showed that smoking history,old age,high PTH and high itch score were independent risk factors of CAC in MHD patients.Conclusion:1.MHD patients had a high incidence of CAC and pruritus,especially in hypertensive nephropathy and diabetic nephropathy patients.2.Smoking history,old age,high PTH and high itch score were independent risk factors for CAC of MHD patients.