The Analysis Of Factors Involved In Pulse Wave Velocity And Cardiovascular Calcification In Patients With Chronic Kidney Disease Stage 5

ObjectiveTo study the relationship between the pulse wave velocity and cardiovascular calcification,and to evaluate if pulse wave velocity can be a predictor of cardiovascular calcification of chronic kidney disease stage 5.To search for factors that may affect pulse wave velocity for the early clinical intervention.MethodsA total of 64 CKD5 patients who were in Heping Hospital of Changzhi Medical College from Oct 10,2007 to Oct 10,2008 were enrolled,32 males,32 females,age 19-76 years(mean age 49.4±13.4 years old).We recorded every patient's name,gender,age,onset time and duration of dialysis,measured and recorded their height(m),weight(kg), blood pressure,and calculated body mass index(body mass index = weight / height ~2).Primary diseases were recorded after they were confirmed.The blood samples and urine samples were collected and inspected in two hours the next day.Another sample was preserved in a -20℃refrigerator after being centrifuged and placed in the EP tube for inspecting parathyroid hormone.Every patients underwent echocardiogram for aortic pulse wave velocity,carotid intima-media thickness,heart and carotid artery calcification,a lateral abdominal X-ray for abdominal aortic calcification.Hb and Hct were detdcted by electrical impedance method,the semiconductor laser flow cytometry and SLS hemoglobin detection.Plasma CRP was deteted by immune turbidimetry.Calcium were deteted by electrode,phosphorus were deteted by colorimetric.PTH was detected by enzyme-linked immunosorbent assay.BUN,Scr,TCH,TG,HDL-C,LDL-C,LP(a),Alb, and BGlu were detected by colorimetry.GFR(glomerular filtration) was calculated by MDRD calculator.Urine protein were detected by H-300 urine dry chemistry analyzer,protein indicator error theory was applied. Patients were divided into PWV＞12 group and PWV＜12 group.At the same time,patients were divided into cardiovascular calcification group and non-cardiovascular calcification.Count data and classification variables were analyzed by X~2 test and Wilcoxon rank-surn test, numerical variables were analyzed by the two samples t test and F test, univariate analysis were analyzed by linear correlation analysis, multivariate analysis were analyzed by multiple linear regression analysis,P＜0.05 means that there is statistical significance.Results1,The incidence of cardiovavascular calcification between PWV≥12 group and PWV＜12 group were significantly different(P＜0.01). 88.8%patients whose PWV＞12 have cardiovascular calcification. 21.3%patients whose PWV＜12 have cardiovascular calcification.PWV were statistically different between cardiovascular calcification group and non-cardiovascular calcification group(P＜0.05).2,Systolic blood pressure,duration of primary disease,Scr,P,Ca×P,PTH,BGlu,Alb,TCH,LP(a),LDL-C,HDL-C,CRP,carotid intima -media thickness and urine protein were statistically different between PWV≥12 group and PWV＜12(P＜0.05).3,Linear correlation analysis revealed that PWV was positively related with systolic blood pressure,duration of primary disease,Scr,P, Ca×p,PTH,BGlu,TCH,LP(a),LDL-C,CRP,carotid intima- media thickness and urine protein(systolic blood pressure r=0.38 P＜0.01, duration of primary disease r=0.516 P＜0.01,Scr r=0.301 P＜0.05,P r=0.316 P＜0.05,Ca×P r=0.273 P＜0.05,PTH r=0.46 P＜0.01,BGlu r=0.32 P＜0.05,TCH r=0.292 P＜0.05,LP(a) r=0.267 P＜0.05,LDL-C r=0.575 P＜0.01,CRP r=0.337 P＜0.01,carotid intima- media thickness r=0.644 P＜0.01,urine protein r=0.332 P＜0.01 ),and was negatively related with Alb and HDL-C(Alb r=-0.267 P＜0.05,HDL-C r=-0.624 P＜0.01). Multiple linear regression analysis revealed that PWV was positively related with P,LP(a),CRP and carotid intima-media thickness(P Beta=0.272 P＜0.05,LP(a) Beta=0.323 P＜0.01,CRP Beta=0.391 P＜0.01, carotid intima-media thickness Beta=0.214 P＜0.05)。4,Systolic blood pressure,duration of primary disease,Scr,GFR,P, Ca×p,PTH,Alb,HDL-C,LDL-C,CRP,carotid intima-media thickness and urine protein were statistically different between cardiovascular calcification group and non-cardiovascular calcification group(P＜0.05). Conclusion1,PWV may be used as a feasible indicator forecasting possibility of cardiovascular calcification for patients with CKDS.2,Higher blood pressure,higher blood glucose,higher low density lipoprotein-cholesterol,higher lipoprotein(a),higher phosphorus,higher parathyroid hormone,more urine protein,are more easily to speed up pulse wave velocity,and lead to the occurrence of cardiovascular calcification in patients with CKD5.3,Lower renal glomerular filtration rate and longer course of primary disease are more easely to lead occurence of cardiovascular calcification in patients with CKD5.4,CKD5 patients with thicker carotid intima media thickness and faster pulse wave velocity are more prone to cardiovascular calcification.