Analysis Of Vascular Calcification And Risk Factors In Maintenance Hemodialysis Patients

Objective: To observe the status of vascular calcification in maintenance hemodialysis(MHD)patients and analyze the influencing factors,so as to provide the basis for effective clinical intervention measures.Methods: A total of 58 patients who were undergoing MHD treatment in the Blood Purification Center of the Third Hospital of Hebei Medical University from October 2020 to January 2021 were enrolled,including 29 patients of diabetic nephropathy(DN group)and 29 patients of non-diabetic nephropathy(NDN group).General data and clinical indicators of the patients were collected.Chemiluminescent immunoassay was applied to detect intact parathyroid hormone(i PTH)levels;Enzyme-linked immunosorbent assay(ELISA)was applied to detect serum interleukin-1beta(IL-1β)、high-sensitivity C-reactive protein(hs CRP)and Apelin levels;Cardiac ultrasound,carotid ultrasound and lateral abdominal X-ray were used to evaluate whether there was vascular calcification.Carotid plaque Crouse score was calculated,and calcification score of abdominal aorta corresponding to the 1st to 4th lumbar vertebrae was performed according to Kauppila semi-quantitative score method.Clinical data and vascular calcification were compared between DN group and NDN group.58 patients were divided into calcified group and non-calcified group according to the presence or absence of vascular calcification.The clinical data of the two groups were compared and the influencing factors of vascular calcification were analyzed.Results: Body mass index(P=0.02),systolic blood pressure(P=0.02),white blood cell count(P=0.012),neutrophil count(P=0.024),IL-1β(P=0.022),hs-CRP(P=0.041)levels were higher in DN group than those in NDN group,while serum creatinine(P=0.002)and i PTH(P=0.046)levels were lower than those in NDN group,the difference was statistically significant.The proportion of patients with dialysis age over 60 months was lower in DN group(P=0.003)than that in NDN group,and the difference was statistically significant.The incidence of overall vascular calcification(89.7%vs 72.4%,P=0.094),cardiac valve calcification(69% vs 44.8%,P=0.063)and carotid artery calcification(86.2% vs 69%,P=0.115)were higher in DN group than those in NDN group,but the difference was not statistically significant.The plaque Crouse score in DN group [7.0(2.7,14.5)vs 2.1(0,7.3),P= 0.025],the incidence of abdominal aortic calcification(62.1% vs34.5%,P= 0.036),and abdominal aortic calcification score [5(0,11)vs 0(0,2.5),P=0.011] were higher in DN group than those in NDN group,and the difference was statistically significant.According to the presence or absence of vascular calcification,the patients were divided into calcified group(47 cases,81%)and non-calcified group(11 cases,19%).The proportion of DN patients was higher in the calcified group than that in the non-calcified group(55.3%vs 27.3%,P=0.094),but the difference was not statistically significant.Age of patients(P<0.05),IL-1β(P=0.017),hs-CRP(P=0.042)levels were higher in the calcified group than those in the non-calcified group,while diastolic blood pressure(P<0.05),albumin(P=0.013),serum uric acid(P=0.031),serum creatinine(P=0.021)and Apelin(P=0.021)levels were lower than those in the non-calcified group,and the differences were statistically significant.Logistic regression analysis showed that age(OR=1.145,95%CI: 1.054-1.245,P=0.001)was an independent risk factor for vascular calcification in MHD Patients.Conclusions:Among MHD patients,the incidence and severity of vascular calcification in DN patients are higher than those in NDN patients.The inflammatory response in DN patients with MHD is more severe,which may be involved in the occurrence and development of vascular calcification.Apelin may be involved in inhibiting the occurrence of vascular calcification,and the specific mechanism needs to be further studied.