Prevalence,progression And Influencing Factors Of Abdominal Aortic Calcification In Patients With Chronic Kidney Disease

Cardiovascular disease(CVD)was the main cause of death in patients with chronic kidney disease(CKD),while vascular calcification(VC)was an important risk factor for CVD,cardiac mortality and all-cause mortality in patients with CKD.Kidney Disease:Improving Global Outcomes(KDIGO)guidelines recommend regular detection of VC starting from CKD3 stage,and recommend the use of economical and convenient lumbar lateral radiographs to evaluate abdominal aortic calcification(AAC).However,currently,studies on VC in CKD patients mainly focus on coronary artery calcification(CAC),while clinical studies on AAC mainly come from maintenance hemodialysis population,and little is known about the risk factors for the progression of AAC.This study intends to evaluate the prevalence and progress of AAC in 634 CKD patients from south China and explore the influencing factors,and evaluate the relationship between bone metabolic indices bone-specific alkaline phosphatase(BALP)and AAC.Study 1: Characteristics and influencing factors of abdominal aortic calcification in patients with chronic kidney disease Objective: To clarify the characteristics of AAC in CKD patients and explore its influencing factors.Methods: A total of 634 CKD patients from January 2014 to August 2019 from the nephrology department and Dongpu branch nephrology department,the hemodialysis center and Dongpu branch hemodialysis center,the first affiliated hospital of Jinan University were enrolled.Evaluation of abdominal aortic calcification score(AACS)was performed on lumbar lateral radiographs,and general demographic and laboratory data were collected.Results: The median AACS in CKD patients was 3,and the prevalence of AAC was70.82%,including 31.39% mild calcification,33.12% moderate calcification and6.31% severe calcification.AAC was found in 37.17% young,63.46% middle-aged,83.65% younger-old age and 96.19% elderly-old age patients(P<0.001).The prevalence of AAC in CKD1-2 stage,CKD3-5 stage and dialysis patients were46.67%,63.33% and 78.07%,respectively(P<0.001).The median AACS in younger-old age patients with CKD1-2 stage reached 1.5 and 3,the prevalence of AAC in young patients with CKD1-2 stage also reached 30.00%,and the prevalence of AAC in middle-aged and younger-old age patients with CKD1-2 stage increased to 34.38% and 59.38%,respectively.The prevalence of AAC in CKD patients with diabetes mellitus(DM)was significantly higher than that without DM(82.59% vs63.31%,P < 0.001).Multivariable logistic analysis found that age,CKD3-5 stage(vs CKD1-2 stage),dialysis(vs CKD1-2 stage)and lg estimated glomerular filtration rate(e GFR)was risk factors for AAC in CKD patients(both P < 0.05).Conclusion: The prevalence of AAC in CKD patients was 70.82%,and that in young patients with CKD1-2 stage reached 30.00%.Age and renal function were closely related to AAC.Study 2: Characteristics and influencing factors of abdominal aortic calcification in patients with dialysis Objective: To clarify the characteristics of AAC in dialysis patients and explore its influencing factors.Methods: A total of 424 dialysis patients from study 1 were enrolled.Evaluation of AACS was performed on lumbar lateral radiographs,and general demographic and laboratory data were collected.Results: The median AACS in dialysis patients was 4,and the prevalence of AAC was 78.07%,including 32.08% mild calcification,37.50% moderate calcification and8.49% severe calcification.There were 45.33% AAC in the young group,75.89%AAC in middle age group,88.06% AAC in younger-old age group,and the prevalence of AAC in the elderly-old age group was up to 97.30%(P<0.001).There were 45.3% AAC in patients with dialysis duration ≤1 year,75.89% AAC in patients with 1-3 years of dialysis duration,and the prevalence of AAC in patients with 3-5years of dialysis duration and dialysis duration >5 years were as high as 89.23% and88.89%,respectively(P<0.001).82.26% dialysis patients with DM had AAC,significantly higher than that without DM(71.90%,P<0.001).After multivariable logistic regression analysis,age,DM,corrected calcium,lg parathyroid hormone(PTH),dialysis duration,1-3 years of dialysis duration(vs dialysis duration ≤1 year),3-5 years of dialysis duration(vs dialysis duration ≤1 year),and dialysis duration >5years(vs dialysis duration ≤1 year)were risk factors for AAC in dialysis patients(all P<0.05).Conclusion: The prevalence of AAC in dialysis patients was 78.07%,in young patients were nearly 50%,and elderly patients were mainly moderate to severe calcification.The age,DM,corrected calcium,PTH and dialysis duration were closely related to AAC.Study 3: Influencing factors of abdominal aortic calcification in dialysis patients: propensity score matching cohort study Objective: The influencing factors of AAC in dialysis patients were analyzed by propensity score matching(PSM)method.Methods: The enrolled patients were the same as in study 2.Patients with moderate/severe calcification were matched 1:1 by PSM according to age,dialysis duration and DM(non-controllable risk factors in study 2)with patients with no/mild calcification.123 patients with no/mild calcification and 123 patients with moderate/severe calcification were matched.Results: The prevalence of AAC in dialysis patients was 75.77%,including 35.77%mild calcification,42.68% moderate calcification and 7.32% severe calcification,which was similar to the results in study 2.After PSM matching,compared with no/mild AAC patients,moderate and severe AAC patients still had higher corrected calcium,blood magnesium and PTH(all P<0.05),while there were no statistical differences in other demographic and laboratory indicators(all P>0.05).Corrected calcium and lg PTH was associated with AAC by multivariable logistic regression analysis(all P<0.05).The area under the receiver operating characteristic(AUROC)curves of corrected calcium and lg PTH for distinguishing moderate/severe AAC were0.619(P=0.003,sensitivity 82.11%,specificity 34.15%)and 0.614(P=0.005,sensitivity 77.67%,specificity 43.81%).The AUROC of combination of corrected calcium and lg PTH was 0.671(P<0.001,sensitivity 60.19%,specificity 66.67%).Conclusion: Corrected calcium and lg PTH were independent risk factors for AAC in dialysis patients.Study 4: Correlation between bone specific alkaline phosphatase and abdominal aortic calcification in patients with chronic kidney disease Objective: To evaluate the level of BALP in CKD patients and explore the relationship between BALP and AAC.Methods: 133 CKD patients who completed BALP tests in study 1 were selected as subjects.Serum BALP was detected by enzyme-linked immuno sorbent assay(ELISA)and serum 25-Hydroxyvitamin D(25(OH)D)was detected by chemiluminescence immunoassay.Results: The prevalence of AAC in CKD patients was 63.91%,including 30.83%mild calcification,25.56% moderate calcification and 7.52% severe calcification;which were similar to study 1.Median BALP was 11.73 ug /L,and the tertile was9.64 ug /L and 14.61 ug /L.The median AACS of each BALP group by tertile was 0,2and 4,respectively.With the increase of BALP,AACS showed a gradual increase trend(P=0.002)and the prevalence of AAC in CKD patients gradually increased(45.45%,68.18% and 77.78% in each tertile group,respectively,P=0.015).Compared with the BALP< 9.64 ug /L group,patients with BALP≥ 9.64 ug /L had higher prevalence of AAC,and patients with BALP≥ 14.61 ug /L had more moderate and severe AAC than those with BALP< 9.64 ug /L(all P<0.05).25(OH)D was19.37±8.79ng/ml,Vit D deficiency and insufficiency accounted for 36.09% and51.88%,respectively,and only 12.03% patients had adequate Vit D.With the increase of 25(OH)D,the prevalence of AAC in CKD patients gradually increased,but there was no significant difference between the groups(P= 0.207).Multivariate logistic regression analysis showed that lg BALP was an independent risk factor for AAC in CKD patients(OR=10.740,95%CI: 2.176-53.007,P=0.004).Conclusion: With the increase of BALP,AACS gradually increased,and BALP was closely related to AAC in CKD patients.Study 5: Progression and influencing factors of abdominal aortic calcification in patients with chronic kidney disease Objective: To analyze the characteristics of AAC progression in CKD patients and explore the influencing factors.Methods: A total of 238 CKD patients enrolled in study 1 were selected,who were reexamined lumbar lateral radiographs after ≥6 months.The AAC progress was defined as ?AACS(follow-up AACS-baseline AACS)>0 and AAC rapidly progresses was defined as annual average of ?AACS>1.28(median).Results: Baseline AAC stratification was similar to study 1.After median follow-up15 months(interquartile range 11-30 months),the median ?AACS and annual average of ?AACS were 2 and 1.28,and 68.49% CKD patients had AAC progression.After follow-up,the prevalence of AAC in CKD patients was up to 84.45%,including26.05% mild calcification,39.08% moderate calcification and 19.33% severe calcification,significantly higher than 69.23% at baseline(P<0.001).49.32% new calcification was observed in patients with CKD who had no calcification at baseline,54.05% patients with mild calcification at baseline developed to moderate/severe calcification,and 32.47% patients with moderate at baseline developed to severe calcification during the follow-up.The median occurrence time of AAC progress was24 months,and the cumulative progress rate of AAC in 1-4 years was 25.10%,54.40%,71.60% and 87.00%,respectively.Multivariate logistic regression analysis showed that the baseline age,baseline dialysis,lg follow-up time,baseline AAC or baseline moderate calcification(vs baseline without calcification)were independent risk factors of AAC progress in CKD patients(all P < 0.05);at the same time,the baseline age,baseline dialysis,DM,baseline moderate calcification(vs baseline without calcification)and baseline severe calcification(vs baseline without calcification)were independent risk factors for AAC rapidly progresses in CKD patients(all P < 0.05).Conclusion: CKD patients had a high rate of AAC progression,with a median occurrence time of 24 months.Age,dialysis status,DM and baseline AAC promoted AAC progression in CKD patients.Conclusion1.The prevalence of AAC in CKD patients was 70.82%,and that in young patients with CKD1-2 stage reached 30.00%.Age and renal function were closely related to AAC.2.The prevalence of AAC in dialysis patients was 78.07%,in young patients were nearly 50%,and elderly patients were mainly moderate to severe calcification.The age,DM,corrected calcium,PTH and dialysis duration were closely related to AAC.3.With the increase of BALP,AACS gradually increased,and BALP was closely related to AAC in CDK patients.4.CKD patients had a high rate of AAC progression,with a median occurrence time of 24 months.Age,dialysis status,DM and baseline AAC promoted AAC progression in CKD patients.