The Study Of Relationship Between The Serum Level Of Sclerostin And Dickkopf1 And Cardiac Valve Calcification In The Maintenance Hemodialysis Patients

Objective:The high incidence of cardiac valve calcification in maintenance hemodialysis patients lead to myocardial remodeling and cardiac function decline,which was related to the occurrence and development of cardiovascular events.Cardiac valve calcification belongs to vascular calcification,and both of which have similar effects and mechanisms.In recent years,Wnt signaling pathway in chronic kidney disease and vascular calcification has recieved widespread attention.As the main inhibitor of the Wnt signaling pathway,both Sclerostin and DKK-1 have a potential relationship with calcification,which may become predictive biological indicators of calcification.The aim of our study was to investigate the correlative factors of cardiac valve calcification in MHD patients and the relationship with serum Sclerostin and DKK-1,which may provide new ideas for early intervention of cardiac valve calcification.Methods:Our study contained MHD patients in Department of Kidney Disease and Blood Purification of the Second Hospital of Tianjin Medical University and Nephrology Department of Tianjin Nankai Hospital from October 2016 to December2017.Based on the presence of cardiac valve calcification according to echocardiography results,the patients were divided into cardiac valve calcification group and non-cardiac valve calcification group.The data was collected including general clinical data:gender,age,primary disease,renal failure,vascular access,height,weight,dialysis duration and blood pressure(systolic/diastolic);color Doppler echocardiography records LVEF,aortic valve calcification and mitral valve calcification;laboratory detection:WBC,RBC,Hgb,BUN Scr,Ca,P,UA,ALB,TC,TG,HDL,LDL,ALP,iPTH,hsCRP,Sclerostin,and DKK-1.Result:1)A total of 114 cases of maintenance hemodialysis patients were enrolled in this study,including 41 cases of primary diabetes(35.9%),27 cases of primary glomerulonephritis(23.7%),27 cases of hypertension(23.7%),13 cases of polycystic kidney disease(11.4%),and other 6 cases(5.3%).According to the presence of cardiac valve calcification,the patients were divided into two groups,including non-cardiac valve calcification group(27 cases)and cardiac valve calcification group(87 cases),The prevalence of cardiac valve calcification was 76.3%.So the incidence of cardiac valve calcification is prevalent in maintenance hemodialysis patients.2)Based on gender,the incidence of cardiac valve calcification in the male MHD patients is 72.7%(48 cases),and the incidence of cardiac valve calcification in the female MHD patients is 81.3%(39 cases).Furthermore,the difference is not statistically significant(?~2=1.117,P=0.291).According to the vascular access,there were 54 cases of long-term catheter and 33 cases of arteriovenous fistula in cardiac valve calcification group,and 12 cases of long-term catheter and 15 cases of arteriovenous fistula in non-cardiac valve calcification group.There was no statistically significant difference between them(?~2=0.366,P=0.545).The role of sex and vascular access on cardiac valve calcification need to be further studied.3)Compared to non-cardiac valve calcification group,serum P,UA,ALP,Sclerostin and DKK-1 levels were more significant in cardiac valve calcification group.The difference was statistically significant(P<0.05).However,there was no significant difference in age,weight,body mass index,pre transmex blood pressure(systolic pressure/diastolic pressure)and dialysis duration between the two groups(P>0.05).Furthmore,there was also no significant difference in WBC,RBC,Hgb,BUN,Scr,Ca,ALB,TC,TG,HDL,LDL,HDL between the two groups.The results showed that serum P,UA,ALP,Sclerostin and DKK-1 may be correlated factors of cardiac valve calcification.4)The relationship between serum P,UA,ALP,Sclerostin,DKK-1 and cardiac valve calcification were analyzed according to Logistic single factor analysis,which showed that P,UA,ALP,Sclerostin and DKK-1 had an evident relationship with cardiac valve calcification.The difference was statistically significant(P<0.05).5)The results showed that UA is not independent risk factors of cardiac valve calcification.Furthermore,serum P,ALP,Sclerostin and DKK-1 were independent risk factors for cardiac valve calcification,whose HR values were 0.219,0.056 6.905,0.188,P=0.041,0.020,0.045,0.029.The difference was statistically significant(P<0.05).6)Based on the average Sclerostin level,the analysis showed that the level of SOST was inversely proportional to iPTH and ALP,meanwhile,has a positive relationship with ALB and HgB,the difference was statistically significant(P<0.05).Based on the average DKK-1 level,the analysis showed that the level of DKK-1 was inversely proportional to the UA,difference was also statistically significant(P<0.05).Conclusion:The prevalence of cardiac valve calcification in maintenance hemodialysis patients is very high.Compared to non-cardiac valve calcification group,SOST,DKK-1,P,ALP and UA levels were significantly higher in cardiac valve calcification group.Serum Sclerostin,DKK-1,P,and ALP are the independent risk factors for cardiac valve calcification in maintenance hemodialysis patients.The resaults suggest that Sclerostin and DKK-1 may have certain protective effects on the cardiac valve calcification,but the mechanism is unclear and need further research.