Meta-analysis Of Influencing Factors For Cardiac Valve Calcification In Maintenance Hemodialysis Patients

Background: Several clinical studies in the last two decades clearly demonstrated that patients with chronic kidney disease(CKD)harboured a significant increase in the risk of cardiovascular events,including coronary artery disease,heart failure and stroke,and cardiovascular disease is the leading cause of end-stage renal disease,which accounts for more than 50% of all-cause mortality.Arterial calcification and the resulting stiff of the arteries are important factors leading to the occurrence of cardiovascular disease in patients with CKD,including cardiac valve calcification.Cardiac valve calcification(CVC)is an important cause of valvular stenosis,often occurs in the aortic valve and mitral valve,which can cause heart valve dysfunction,lead to valve stenosis or insufficiency,and hemodynamic changes.Although the incidence of cardiac valve calcification compared with the incidence of arterial calcification is lower,the incidence of cardiac valve calcification in patients with CKD is 5-10 times higher than in patients with normal renal function,and dialysis is also a risk factor of cardiac valve calcification in CKD patients,including hemodialysis and peritoneal dialysis,the incidence of cardiac valve calcification in dialysis patients is four-five times higher than in the general population,and the incidence of cardiac valve calcification in maintenance hemodialysis(MHD)patients are more common,which progresses faster than general population.There are many studies on heart valve calcification in MHD patients,but there are great controversies about its pathogenesis and treatment.There are growing evidences showing that,in addition to traditional cardiovascular risk factors,mineral metabolic abnormalities,inflammatory response,are also involved in the incidence and development of CVC.This study did meta analysis about case-control studies in latest 15 years,which involved the influencing factors of the patients with cardiac valve calcification in MHD,aiming to provide a more comprehensive understanding of the influencing factors of cardiac valve calcification in MHD patients,and explore the relevant treatment,furthermore reduce the mortality of MHD patients and improve the quality of life in MHD patient.Objective: To explore the influencing factors for cardiac valve calcification in MHD patients,we conduct this meta-analysis.Method: Based on Meta-analysis of Observational Studies in Epidemiology(MOOSE)of observational studies was to study and write.Relevant studies on cardiac valve calcification in MHD patients were searched through Embas,Pubmed,Web of Sciences,CNKI,Wan Fang,VIP and CBM from January 2000 to October 2015.Meta-analysis was performed using Rev Man 5.3 software,and using Stata 13.0 software for biased analysis.Result: A total of 16 studies involving 3061 participants(including 1541 cases and 1520 controls)were included.The result of meta-analysis showed: 1)There are some factors for cardiac valve calcification of MHD patients that are older [WMD=9.64,95%CI(7.75,11.52),P<0.001],longer durations of HD [WMD=25.87,95%CI(15.90,35.83),P<0.001],higher phosphorus [WMD=0.57,95%CI(0.22,0.92),P=0.001],higher CRP levels [WMD=3.13,95%CI(1.29,4.95),P<0.001],higher FGF-23 [WMD=0.5,95%CI(0.21,0.79),P<0.001],the differences are statistically significant(P<0.01).2)Cardiac valvular calcification in patients with maintenance hemodialysis is associated with decreased serum albumin levels [WMD=-0.88,95%CI(-1.41,-0.36),P=0.001] and decreased levels of fetuin-A [SMD=-1.24,95%CI(-1.83,-0.65),P < 0.001],the differences are statistically significant(P<0.01).Conclusions: The important risk factors of cardiac valve calcification in MHD patients are age,durations of HD,Phosphorus,CRP levels and FGF-23.The protective factors are albumin,fetuin-A.