| Objective: We aim to evaluate the nutritional status, level of blood pressure, calciumand phosphorus metabolism, survival prognosis of peritoneal dialysis patients in peritonealdialysis center of Second Affiliated Hospital of Soochow University. We also investigatedthe characteristics of heart valve calcification in peritoneal dialysis patients, and analyzedthe possible risk factors of cardiac aortic and mitral valve calcification, as well as itsinfluence on prognosis.Methods:1.117cases of peritoneal dialysis patients in our peritoneal dialysis centerafter January,2006were included. All patients had done peritoneal dialysis more than18months. Ultrasound was used to assess cardiac valve calcification（CVC）. Depending onwhether CVC was diagnosed, patients were divided into CVC group and non-CVC group.The definition of valve calcification is that one or more strong echo of greater than1mmwas detected. We collected clinical data of all patients, and measured biochemical andelectrolyte, blood calcium and phosphorus, etc. We detect total weekly KT/V andperitoneal transport function (PET) when patients under steady state. Cross-sectionalcomparative research was used to evaluate nutritional status, dialysis adequacy, calciumphosphorus metabolism indicators between CVC group and non-CVC group. We analysispossible risk factors that may leads to heart valve calcification.2. We choose one hundred and twelve patients between January2009and December2011from peritoneal dialysis center of Second Affiliated Hospital of Soochow University.The patients were followed until December,2013. Endpoint events were death or switch tohemodialysis. According to whether accompanied with heart valve calcification or notwhen they started dialysis, patients were divided into valve calcification group and nonvalve calcification group. We calculated glomerular filtration rate effectively of patients asresidual renal function. Survival between with or without valve calcification was comparedusing Kaplan-Meier analysis. A Log-rank test was used to significance analysis and Cox proportional hazards analysis was performed to determine Relative Risks.3. Statistical analysis was performed using SPSS for Windows, version17.0(SPSS Inc,Chicago, IL, USA), analysis, p <0.05was considered statistically significant.Results:1.(1) There were a total of42patients with heart valve calcification,including4patients with mitral valve calcification merely,25patients with aorticcalcification merely,13patients with aortic and mitral valve calcification.(2) Comparedwith those without aortic valve calcification, patients with aortic valve calcification wereolder, and had higher CRP, higher low density lipoprotein cholesterol, higher totalcholesterol, longer duration of hypertension, larger the product of the hypertension gradeand course, and lower pre-albumin, the difference was statistically significant. Bloodalbumin, hemoglobin, blood calcium, blood phosphorus, the calcium-phosphorus productand PTH were similar between the two groups.(3)Compared with those without mitralvalve calcification, patients with mitral valve calcification were older and had longerdialysis duration, lower pre-albumin. Blood phosphorus, calcium-phosphorus product, andCRP were higher in those with mitral valve calcification. The difference between the twogroups was statistically significant.(4) The multifactor regression Logistic analysisshowed that age (every10years of age), the calcium-phosphorus product wereindependently associated with valve calcification, and there was independent negativecorrelation between pre-albumin and heart valve calcification.(5) Next we separatelyplugged aortic valve calcification or mitral valve calcification as the independent variableinto single factor regression analysis, variables when P <0.1were selected as the covariateinto multifactor regression. Age (OR=1.965, p=0.01), diabetes history (OR=4.693, p=4.693), and the calcium-phosphorus product (OR=2.373, p=2.373) and pre-albumin (OR=0.908, p=0.908) were associated with aortic valve calcification independently. Age (OR=3.179, p=3.179), the calcium-phosphorus product (OR=6.512, p=6.512), pre-albumin(OR=0.885, p=0.885), high density lipoprotein (OR=19.540, p=19.540), diabeteshistory (OR=6.948, p=6.948) were independently associated with mitral valvecalcification.(6) Left atrial diameter were larger in those with heart valve calcification, butejection fraction (EF), E/A value, left ventricular posterior wall thickness andinter-ventricular septal thickness were similar between the two groups. Thickness ofinter-ventricular septum and left ventricular posterior wall thickness were correlated withHigh blood pressure grade, p <0.05; Left ventricular diastolic diameter and left ventricular contraction diameter, distance of valve open and E/A value were correlated with age (p <0.05).2.(1) There were19patients with heart valve calcification among all of112patientswhen started to peritoneal dialysis, the incidence of16.96%. All patients with an averageage of58.24±15.23years,69cases of male. During follow-up period,26patients died, andthe overall survival time for112patients was50.1±1.7months.(2) Using nonparametricproduct limit estimation method (Kaplan-Meier) to calculate the cumulative survival ratewhen one year, two years, three years after dialysis in both groups, the valve calcificationgroup of cumulative survival respectively were89.5%、82.6%、24.1%, and that of nonvalve calcification group respectively were90.9%、86.2%、84.7%, the Log-rank testcomparison: Chi-square value=21.126, P <0.000, the difference is statistically significantdifference.(3) Correction confounders by multiple factors Cox proportional risk analysiswe found that valve calcification group significantly increased risk of death: RR=3.319, P=0.022, and independent of the low pre-albumin levels, elder and other factors.Conclusion:1.The maintenance peritoneal dialysis patients had a high morbidity ofvalve calcification. Age, diabetes history, the calcium-phosphorus product, low serumpre-albumin levels are independent risk factors for the development of aortic valvecalcification. And the independent risk factors of mitral valve calcification are age, thecalcium-phosphorus product, low serum per-albumin.2. Patients had high mortality with heart valve calcification when started to peritonealdialysis, is he independent risk factors affecting prognosis. |
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