| Objective:The purpose of this study is to investigate the factors correlated to coronary artery calcification in maintenance hemodialysis patients, further to observe the effect of sodium thiosulfate(STS) on the progression of vascular calcification and its safety.Methods:All subjects underwent coronary artery CT scan using Philip’s spiral CT and the calcification degree was evaluated by calcification scores. The hemodialysis patients were divided into coronary artery calcification group(CAC scores >10) and non-coronary artery calcification group according to the CT scan result. The levels of serum calcium, phosphate, parathyroid hormone(PTH), C reactive protein(CRP), and serum albumin(Alb), blood lipids, and hemoglobin were measured before hemodialysis. Meanwhile, the product of calcium and phosphate was calculated. The diferences of age, duration of dialysis, blood pressure and other hematological indexes between the two groups were analyzed. Those with coronary artery calcification(CAC scores >50) received intravenous 0.18g/kg STS(dissolved in 100 ml saline) in 30 minutes after each dialysis for 3 months(n=17, Only 15 patients completed STS treatment) or received conventional treatment(n=10). The levels of liver and renal function, electrolytes, blood lipids, routine blood, PTH, CRP, 25-hydroxy vitamin D(25(OH)D), bone alkaline phosphatase(b ALP), fibroblast growth factor 23(FGF23), bone mineral density(BMD) and other related examinations were measured before the test. All examination indexes were reevaluated at the end of the treatment course. The relevant factors were analyzed affecting vascular calcification, and changes of vascular calcification imaging, biochemical and bone mineral density were compared between two groups before and after the treatment. Besides, adverse reactions were observed during the treatment of STS.Results:1. 27 in 38 patients(71.05%) had coronary artery calcification, The patients with coronary artery calcification had significantly higher age, duration of dialysis,phosphate, the product of calcium and phosphate, PTH and CRP(P=0.017, 0.005, 0.037, 0.038, 0.037, 0.013, 0.006) and lower serum albumin(P=0.026) than patients without coronary artery calcification. 2. There was no significant difference in the baseline characteristics. CAC score was unchanged in the STS treatment group(P=0.053), but increased significantly in the conventional treatment group(P=0.021). Difference of calcification score parameters before and after treatment showed statistically significant difference between the two groups(P= 0.004). After STS treatment, CRP levels decreased(P=0.016), HCO3- levels decreased(P=0.020), and serum calcium levels increased(P=0.005). No change was identified with other indicators in including PTH, 25(OH)D, b ALP, FGF23 after STS treatment. 3. Sodium Thiosulfate’s adverse reactions: nausea and vomiting in 3 patients, fatigue in 1 patient, thirst in 2 patients, sneezing in 1 patient, decreased bone density in 5 cases. Decreased bone mineral density occurred in 1 case in the conventional treatment group; chi-squared test of bone mineral density showed no statistically significant difference(X2=1.791, P= 0.345).Conclusions:1. Coronary artery calcification is commonly present in maintenance hemodialysis patients. It is affected by many factors such as age, duration of dialysis, metabolic disorders of calcium and phosphate, inflammation and malnutrition status. 2. STS treatment seems to be feasible, safe and may decrease the rate of progression of vascular calcification in maintenance hemodialysis patients. |
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