Multivariate Analysis Of Vascular Calcification In End Stage Renal Disease

Background: Cardiovascular and cerebrovascular diseases is the leadingcause of death in patients with ESRD hemodialysis patients. The incidenceup to60%,10-20times as general population. Vascular calcification is the majorrelevance factor of cardiovascular and cerebrovascular diseases.The factors thatlead to vascular calcification in addition to traditional factors such ashypertension, diabetes，as well as other non-traditional factor such as calciumand phosphorus metabolism. Reciprocal causation among the various factorsaffecting each other through the same or different mechanisms, acceleratingvascular calcification and other important organs failure. Fully understandingthe relevant factors of the occurrence and the development of vascularcalcification in CKD patients, strengthening the prevention and treatment ofvascular calcification have significance to maintain kidney disease patientssurvival years and improve the quality of life in ESRD patients.Objective: Vascular calcification assessment of Patients with end-stagekidney disease and Multivariate.Methods: Choose59patients with chronic kidney diseases who need toperform an operation of native arteriovenous fistula. A piece of radial arterywas removed during the operation. The arteries were examined histologicallyfor calcification by HE staining and von Kossa staining. Then grade accordingto the deposits of calcium salts, compare among the levels on the generalinformation, indicators, and echocardiography. Using the SPSS18.0, analyzethe measurement data with ANOVA, and each two groups with LSD test orDunnett’s test. Analyze count data with χ2test, and skewed distributioncontinuous variables with rank sum test (Kruskal-Wallis method). Give the relevance analysis to the possible factors of vascular calcification and thenanalyze the high risk factors with multiple stepwise regression.Results:1. General Information: among59patients，there are9cases (15.3%) inSevere calcification group,10cases (16.9%) in Moderate calcification group,21cases(35.6%) in Mild calcification group and19cases（32.2%） in Nocalcification group.Chronic glomerulonephritis was main primary disease in kidney diseaseof all the59patients. Female ratio was2.47:1, the difference was notstatistically significant (P>0.05). Age of four groups were significantlydifferent(P<0.01), the age of the No calcification grou is yonger than the othergroups (P<0.01);The history of smoking of four groups were different(P<0.05).2. Laboratory Index: There were significant differences among fourgroups in total cholesterol (TC),phosphorus,calcium phosphorus product,highsensitive C-reactive protein (P<0.01). There were statistical differences in lowdensity lipoprotein choleste,fibrinogen,calcium among four groups(P<0.05).But there were no significant difference in creatinine(scr),uric acid,24-hoururinary protein,triglyceride (TG),high density lipoprotein cholesterol(HDL-C),kalemia,natremia,chlorine,carbon dioxide combining power (CO2CP),neutrophils,the percentage of neutrophils,thyroid-stimulating hormone,FT3,FT4among four groups (P>0.05).3.Test results: There were statistically significant differences among fourgroups in AOD(Aortic root diameter), LVM(Left Ventricular Mass), FS,EF(P<0.01); There were statistical differences in IVST(Interventricular septalthickness), LVDd(Left ventricular end diastolic dimension)(P<0.05). But therewere no statistically differences among four groups in other index(P>0.05).4. Relationship：Vascular calcification and age, smoking history, hyper-tension history, cholesterol, fibrinogen, serum phosphate, calcium phosphorus product, high sensitivity C reactive protein, AOD, IVST, LVDd, LVM weresignificantly positively correlated (P<0.01). Vascular calcification and highdensity lipoprotein cholesterol wrere negative correlation(P<0.05).Vascularcalcification and Ordinal regression analysis showed that age was anindependent risk factor for end-stage renal disease in patients with vascularcalcification (P <0.05).Conclusion:1. Different degree of vascular calcification in ESRDpatients’ radial artery after Von Kossa staining.2. Vascular calcification inESRD patients affected by multi-factors.Vascular calcification and age,smoking history, hyper-tension history, cholesterol, fibrinogen, serumphosphate, calcium phosphorus product were significantly positively correlated;Vascular calcification and high density lipoprotein cholesterol wrere negativecorrelation.3. Mainly changes of heart with the aggravating of vascularcalcifica-tion were thickening of left ventricular posterior wall, increases ofLVM and decrease of heart function.4. Age is a risk factor for vascularcalcification in ESRD patients.