The Incidence Of Carotid Atherosclerosis And Its Influencing Factors In Patients With Peritoneal Dialysis And Vitamin D Deficiency

Objective Atherosclerotic vascular disease is one of the most common complications in patients with end stage renal disease(ESRD),and is a major risk factor for the decline or even death of peritoneal dialysis patients.Most patients with peritoneal dialysis may have vitamin D deficiency.This study was designed to investigate the neck of patients with peritoneal dialysis with vitamin D deficiency byobserving the levels of25-hydroxyvitamin D(25(OH)D)in patients with continuous ambulatory peritoneal dialysis(CAPD).The incidence of atherosclerosis and its influencing factors,in order to provide a certain basis for clinical work.Methods A total of 123 patients who underwent CAPD in the Affiliated Hospital of Qingdao University from August 1,2016 to August 1,2018 were selected for cross-sectional investigation and retrospective study to determine peripheral venous hemoglobin(Hb)and serum creatinine.(Scr),urea nitrogen(BUN),blood calcium(Ca),blood phosphorus(P),albumin(ALB),triglyceride(TG),low density lipoprotein(LDL),C-reactive protein(CRP),procalcitonin(PCT),etc.,the level of 25(OH)D in the serum of all selected patients was measured by enzyme-linked immunosorbent assay(ELISA).Ultrasound was used to detect the carotid intima-media thickness(CIMT)and the number of carotid plaques in all patients.The measurement data conforming to the normal distribution is expressed by the mean±standard deviation,and the measurement data not conforming to the normal distribution is expressed by the median and interquartile range;the adoption rate or composition ratio of the counting data is compared between the two groups.The test or rank sum test;the rate was compared by X~2test;the vitamin D deficiency group and the vitamin D normal group single factor logistic analysis P<0.05independent variable was included in multivariate logistic regression analysis,statistical analysis was processed by SSPS20.0 software,to P<0.05 considered the difference to be statistically significant.Result 1.A total of 123 patients with CKD underwent peritoneal dialysis,including 51(41.5%)with normal vitamin D(25(OH)D?30ng/ml)and vitamin D deficiency(25(OH)D<20ng/ml),There were 72 patients,and about 58.5%of patients with CAPD had vitamin D deficiency.2.Compared with the normal group of vitamin D,the vitamin D deficiency group was older(P<0.001),and was associated with hypocalcemia(P=0.006),hyperphosphatemia(P<0.001),and high calcium-phosphorus product(P<0.001)and high procalcitonin levels(P<0.001).However,there was no significant difference in gender,dialysis time,eGFR,Kt/V,24-hour ultrafiltration volume,primary disease and main drug use between the two groups(P>0.05).3.The incidence of carotid atherosclerosis in peritoneal dialysis patients was 69.1%(85/123).The incidence of carotid atherosclerosis in patients with vitamin D deficiency was 80.5%(58/72),which was significantly higher than that of normal patients with vitamin D.(52.9%,27/51),the difference was statistically significant(P=0.001).In addition,the intima-media thickness and number of arterial plaques were higher in the vitamin D-deficient group than in the normal vitamin D group(inner-media thickness:P<0.001;plaque:P=0.026).4.The risk factors of carotid atherosclerosis in CKD patients with peritoneal dialysis showed that the plasma 25(OH)D level in the atherosclerosis group(Atherosclerotis,AS)was 34.4±11.7 ng/ml,which was significantly lower than that in the non-AS group.(71.3±17.5 ng/ml),the difference was statistically significant(P<0.001).Further multivariate analysis showed that vitamin D deficiency increased the risk of carotid atherosclerosis in patients with CKD undergoing peritoneal dialysis(OR=1.33,95%CI=1.07-1.62,P=0.012).In addition,higher age(OR=1.05,95%CI=1.01-1.08,P=0.026),smoking(OR=1.38,95%CI=1.27-3.21,P=0.034),combined with type 2 diabetes(OR=2.97),95%CI=1.83-4.21,P<0.001),high LDL levels(OR=1.42,95%CI=1.17-2.84,P=0.020)were independent risk factors for carotid atherosclerosis in peritoneal dialysis patients with CKD.Conclusions1.More than half of CAPD patients have vitamin D deficiency.2.The incidence of carotid atherosclerosis in patients with vitamin D deficiency is higher than those with normal vitamin D.3.Vitamin D deficiency,advanced age,smoking,type 2 diabetes,high LDL level is an independent risk factor for carotid atherosclerosis.