| Background and objectiveCoronary artery calcification(CAC)is a common complication in patients with end stage renal disease(ESRD),the incidence rate is up to 68.3%in dialysis patients.,especially prominent in maintenance hemodialysis(MHD).CAC is one of the clinical manifestations of chronic kidney disease-mineral and bone disordor(CKD-MBD),the intimal or medial calcification of the coronary arteries is mainly pathologically manifested,and the medial calcification is the main type.In addition,CAC is associated with poor prognosis in patients with MHD,it is an important cause of severe cardiovascular disease(CVD)in patients with chronic kidney disease(CKD),and is closely related with cardiovascular mortality and all causes mortality.Multislice spiral computerized tomography(MSCT)is the "gold standard" for detecting coronary calcification,and the result is expressed as a coronary artery calcification score(CACS).This study started with CACS,and explored the incidence,distribution,annual progression rate,and related risk factors of CAC occurrence and development in patients with MHD in our center in order to better guide clinical treatment.Materials and methodsAccording to the inclusion and exclusion methods,102 patients with MHD in the First Affiliated Hospital of Zhengzhou University from July 2017 to October 2017 were included.Collect the basic information of the patient's gender,age,dialysis age,primary disease,etc.,and measure and record the blood routine?biochemical indicators?iPTH?FGF23?25 hydroxyvitamin D of the patient at baseline and every 3 months during the follow-up period.According to the test results,adjust the relevant medications of the patient and record according to the guidelines.There was no particular restrictions of patients' medication.The follow-up time was 2 years.At the end of the follow-up,the CKD-MBD related time average serum index was calculated.MSCT imaging examinations were performed at baseline and at the end of follow-up to assess whether patients had coronary calcification,calcification distribution,severity,and progression.The patients were divided into the calcified group and the non-calcified group according to whether the patients had baseline calcification,and the general conditions and biochemical indicators of the two groups were compared.Based on the changes in the CACS of baseline and the follow-up,the patients were divided into a CAC progression group and a CAC non-progression group.The baseline and related time average biochemical indicators of the two groups were compared for differences.Logistic regression was performed with the occurrence of CAC and the progression of CAC as the dependent variables to analyze the risk factors for the occurrence and development of coronary calcification in MHD patients.Results1.There were totally 102 patients included in our center,including 56 males(54.90%)and 46 females(45.10%).The average age was(43.30±12.91)years,and the average dialysis age was(53.26±26.98)months.The three leading causes of chronic renal failure are:chronic glomerulonephritis(56.86%),diabetic nephropathy(19.61%),and hypertensive renal damage(11.76%).2.The proportion of MHD patients with coronary calcification at baseline in our center was 70.59%,and the median CACS was 107.The degree of calcification was inconsistent in the branches of the coronary artery(P=0.001).The incidence and degree of calcification in the right coronary and anterior descending branches were more severe,followed by the left circumflex branch,and finally the left coronary trunk.3.According to baseline coronary calcification,patients were divided into calcified group(n=72)and non-calcified group(n=30).The general situation and laboratory comparison of calcified group and non-calcified group are as follows:male proportions,age,diabetes proportions(P<0.05)in the calcified group are higher than those in the non-calcified group.The levels of alkaline phosphatase(ALP),CACS,and low-density lipoprotein(LDL)in patients with coronary calcification were higher than those without calcification(P<0.05).Dialysis age,body mass index(BMI index),hypertension proportion,smoking ratio,medication,hemoglobin(Hb),albumin(Alb),urea nitrogen(BUN),serum creatinine(Scr),uric acid(UA),triglycerides(TG),cholesterol(CHO),high density lipoprotein(HDL),corrected calcium,magnesium,Phosphorus,intact parathyroid hormone(iPTH),25-hydroxyvitamin D,urea clearance index(Kt/V),and logarithm of fibroblast growth factor(lgFGF23)were not statistically different between the two groups(P>0.05)4.The cumulative incidence of coronary calcification in NHD patients during follow-up was 79.59%,which was higher than the baseline(P=0.028);the median CACS was 209,which was not statistically different from the baseline(P=0.286).During follow-up,the calcification of coronary branches progressed more than the baseline,and there was no was statistically difference(P>0.05).The average annual CAC progression rate is 23.50%.5.According to the progression of coronary calcification,patients were divided into progressive group(n=62)and non-progressive group(n=36).The general situation and laboratory comparison of progressive group and non-progressive group are as follows:the patients in the CAC progressive group were older,the dialysis vintage was longer,the incidence of baseline coronary calcification was higher(P<0.05).During the follow-up period,the CAC progressive group had the higher calcium-using ratio than the non-progressive group(P<0.05);Baseline ALP,CHO,LDL and CACS in the CAC progressive group were higher(P<0.05),and 25-hydroxyvitamin D was lower(P<0.05).There was no statistical difference between the two groups of sex ratio,diabetes ratio,hypertension ratio,smoking ratio,BUN,Scr,TG,HDL,calcium,phosphorus,iPTH,LgFGF23,uric acid,and magnesium(P>0.05).6.Multivariate logistic regression analysis showed:male(OR=2.053,95%CI 1.296?46.818,P=0.025),ALP elevated(OR=1.033,95%CI 1.001?1.066,P=0.041),LDL elevated(OR=1.524,95%CI 1.250?16.856,P=0.022)were independent risk factors for coronary calcification in MHD patients;Time average blood phosphorus level(TA-Pi)>1.78mmol/L(OR=1.395,95%CI 1.034?15.53.P=0.045),time-averaged parathyroid hormone level(TA-iPTH>600pg/ml(OR=1.765,95%CI 1.307?26.130,P=0.021)were independent risk factors for coronary calcification progression in patients with MHD.Conclusions1.The prevalence of coronary calcification at baseline in MHD patients in our center is 70.59%,the cumulative incidence of coronary calcification after a 2-year follow-up period is 79.59%,and the annual progression rate is 23.50%;2.The degree of calcification of the coronary branches of MHD patients is inconsistent.The right coronary artery and the left anterior descending branch are the most severe,followed by the left circumflex branch,and the lightest is the main coronary artery.3.Men,elevated ALP,and elevated LDL are independent risk factors for coronary calcification in MHD patients;4.Persistent high blood phosphorus and high PTH levels are independent risk factors for the progression of coronary calcification in MHD patients... |
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