Association between serum soluble Klotho level and outcome in patients on maintenance hemodialysis

Objective To determine the relationship between serum soluble Klotho (sKL) level and adverse outcome in maintenance hemodialysis (MHD) patients. Methods One hundred and twenty nine cases of MHD patients were collected prospectively. Serum sKL was detected by ELISA. Abdomen lateral plain was used as a criterion to determine the abdominal aortic calcification. The abdominal aortic calcification score (AAC) was calculated. Cox regression analysis was used to determine the risk factor of cardiovascular death (CVD) in MHD patients. Kaplan-Meier showed the relationship between sKL and CVD in MHD patients. Results There were 27 cases (20.9%) of all-cause death and 19 cases (14.7%) of cardiovascular death. The median sKL was 612.6(379.2-816.6) ng/L, and log[iPTH] was an independent factor of sKL concentration. Low sKL had high AAC and CVD death rate. Kaplan-Meier method showed that the all-cause death rate was similar between two groups, and CVD death rate increased significantly in low sKL patients (P=0.036). Cox regression indicated that lower sKL level was associated with high CVD death rate [OR=0.352, 95%CI(0.127- 0.977), P=0.045].After adjustment for the general condition, biochemical indicators, the relationship still existed [OR=0.331, 95% CI (0.117-0.933), P=0.037]. In no or mild vascular calcification patients (AAC≤4), compared with high sKL patients, low sKL patients had no significant difference rate in all-cause mortality. The CVD mortality was significantly higher in high sKL (P=0.035) compared with low sKL. In severe calcification group (AAC＞4),all-cause death and CVD death rates were similar between different sKL groups (P=0.991 and 0.522, respectively). Conclusions Lower sKL has the high CVD death rate and sKL level decreasing is an independent risk factor for CVD death in MHD patients. The lower sKL concentration in MHD patients with no or mild calcification may predict CVD mortality. This study suggests that sKL levels may be helpful in predicting the outcome of patients with MHD.     

Association of serum FGF23 with abdominal aortic calcification and outcomes in maintenance hemodialysis patients

Objective To explore the association of fibroblast growth factor-23 (FGF23) with abdominal aortic calcification(AAC) and adverse outcomes in maintenance hemodialysis patients. Methods One hundred and fourteen cases of MHD patients were collected prospectively. Serum intact FGF23 was detected by ELISA. Abdomen lateral plain was used as a criteria to determine the abdominal aortic calcification and the abdominal aortic calcification score was counted. Logistic regression analysis was used to determine the risk factors of AAC. Kaplan-Meier analysis was applied to compare the survival rate among different groups and COX regression analysis was used to determine the association of FGF23 and mortality in MHD patients. Results Seventy-six patients present abdominal aortic calcification. The median of AACS was 4.0(0.0, 11.0). The median level of FGF23 was 7277.4(2535.0, 9990.8) pg/ml. The median follow-up duration was 72.0(67.8, 72.8) months. During the follow-up, 22 patients (19.3%) died of all-cause death and 17 cases (14.9%) died of cardiovascular diseases. Serum FGF23 level was positively correlated with AAC (r=0.285, P=0.002). Logistic regression analysis showed that longer age (OR=1.059, 95%CI: 1.020-1.100, P=0.003) and dialysis vintage (OR=1.009, 95%CI 1.000-1.017, P=0.039), smoking history (OR=3.010, 95%CI 1.177-7.696, P=0.021) and higher FGF23 level(OR=2.831, 95%CI 1.010-7.937, P=0.048) were independent risk factors of moderate to severe AAC in MHD patients. Kaplan-Meier survival curves showed that the patients with AACS≥5 had significantly higher all-cause mortality(P=0.028) and CVD mortality (P=0.035) than those with AACS＜5. However, the Kaplan-Meier analysis showed no significant difference regarding the level of serum FGF23 with the all-cause and CVD mortality. Cox regression demonstrated that FGF23 was not associated with increased mortality risk, neither in crude nor in multivariate adjusted models. Conclusions Abdominal aortic calcification had a high prevalence in MHD patients. The all-cause and CVD mortality was higher in patients with moderate to severe AAC. FGF23 was an independent risk factor of moderate to severe AAC, but it can't yet be a predictor for the all-cause and CVD mortality of MHD patients.     

Conjunctival and corneal calcificationin is associated with abdominal aortic calcification in maintenance haemodialysis patients

Objective To determine the condition of conjunctival and corneal calcificationin in maintenance haemodialysis patients, and explore the relationship between conjunctival and corneal calcificationin (CCC) and abdominal aortic calcification (AAC). Methods CCC was evaluated by slit-lamp eye photographs, and was graded and scored according to Porter’s classification system in the literature. Abdomen 1ateral X-ray examination were used as a criteria to determine the abdominal aortic calcification. The abdominal aortic calcification (AAC) score was calculated. Spearman correlation coefficient was used to analyze the relationship between CCC and AAC. Logistic regression analysis was used to determine the risk factor of CCC in MHD patients. Results Ninety-eight MHD patients were recruited. Their average age and dialysis vintage were (61.89±12.54) years and 51.67 (3.00～192.00) months, ninety-seven patients had conjunctival and corneal calcificationin, and seventy-two patients had abdominal aortic calcification, The median CCC was 8 (0, 17), the median AAC was 6 (0, 20), and the CCC was positively correlated with AAC (r=0.376, P＜0.001). Compared with the patients of CCC score≤5, the patients of CCC score＞10 had a higher level of phosphate, calcium-phosphate product, iPTH, hs-CRP, and longer dialysis vintage, as well as a higher score of AAC (all P＜0.05). Multivariate logistic regression analysis showed that the higher score of AAC and the longer dialysis vintage were independent risk factors for severe corneal calcificationin calcification. Conclusions Conjunctival and corneal calcificationin is common in MHD patients, and CCC is positively associated with AAC, the risk of CCC rises as a result of a severer AAC and a longer dialysis vintage.     

应用腰椎侧位片评价血液透析患者腹主动脉钙化

目的 应用X线平片腹主动脉钙化评分探讨维持性血液透析( MHD)患者腹主动脉钙化患病率和相关危险因素分析.方法 选取我院资料完整的155例MHD患者为研究对象.通过X线腰椎侧位片检测腹主动脉钙化( AAC)并对其进行评分.结果 155例的腰椎侧位片中,腹主动脉钙化主要发生在第4腰椎节段,并随着节段的上升而逐渐减少.63.63％患者的侧位平片上可见腹主动脉钙化;28.39％患者可见严重腹主动脉钙化(钙化累及3个节段以上).MHD患者的年龄(OR=1.094,P＜0.01)、透析龄(OR=1.013,P=0.022)、血三酰甘油(OR=1.261,P=0.030)和血磷(OR=1.324,P=0.023)水平是发生腹主动脉钙化的独立危险因素,而白蛋白(OR=0.239,P=0.013)为保护性因素.结论 MHD患者腹主动脉钙化患病率高,且与多个血管钙化因素相关.半定量的X线腰椎侧位片方法价格便宜、操作简便,易于临床推广.其对MHD患者的预测价值有待日后更多的随访研究.     

Assessment and risk factors of abdominal aortic calcification in peritoneal dialysis patients

Objectives To evaluate the incidence and risk factors of abdominal aortic calcification (AAC) in chronic kidney disease (CKD) stage 5 patients undergoing peritoneal dialysis (PD). Methods Eligible CKD stage 5 patients undergoing PD in Renji Hospital, Shanghai Jiao Tong University School of Medicine were enrolled in present study. Demographic features, blood pressure, laboratory parameters, residual renal function (RRF), dialysis adequacy and medication were determined. Lateral abdominal X-ray plain film was used to assess AAC, and abdominal aortic calcification score (AACS) was calculated. Risk factors for AAC were analyzed by Logistic regression. Results A total of 206 PD patients aged (55.6±15.0) years with median PD duration 20 (8, 44) months were enrolled in present study. Among them, 108 (52.4%) patients were males and 35(17.0%) complicated with diabetes mellitus. AAC was presented in 118 (57.3%) patients, and 49 (23.8%) patients had severe calcification (calcification involving more than 3 lumber segments). Compared to those without AAC, patients with AAC were elder [ (62.3±11.9) years old vs (46.7±13.9) years old, P＜0.01], had longer PD duration [28(11, 57) months vs 16(7, 29)months, P＜0.01], higher diabetic nephropathy （18.6% vs 6.8%, P＜0.05）and diabetic incidence（23.7% vs 8.0%, P＜0.01）proportion, higher pulse pressure [52.0(44.0, 66.3) mmHg vs 48.0(40.0, 58.0) mmHg, P＜0.05], lower diastolic blood pressure[(81.4±11.7) mmHg vs (88.6±14.6) mmHg, P＜0.01] and mean arterial pressure [ (99.6±13.3) mmHg vs (104.8±15.1) mmHg, P＜0.05], higher high-sensitivity C-reactive protein [2.8(0.7, 5.6) mg/L vs 1.1(0.3, 4.4) mg/L, P＜0.05], lower serum albumin [ (36.9±4.5) g/L vs (38.7±4.5) g/L, P＜0.01], pre-albumin [ (373.2±89.1) g/L vs (404.9±74.7) g/L, P＜0.01], high density lipoprotein [1.1(0.9, 1.4) mmol/L vs 1.3(0.9, 1.5) mmol/L, P＜0.05], and total creatinine clearance rate [(59.1±18.9) L•week-1•(1.73 m2)-1 vs (67.8±29.8) L•week-1•(1.73 m2)-1, P＜0.05]. Logistic regression showed that old age (OR=1.104, 95%CI 1.071-1.138, P＜0.01) and high calcium phosphorus product (OR=1.467, 95%CI 1.037-2.074, P＜0.05) were independent risk factors for AAC, while RRF (OR=0.858, 95%CI 0.740-0.995, P＜0.05) as a protective factor. Conclusions AAC is prevalent in CKD stage 5 patients undergoing PD. Advancing age and high calcium phosphorus product are independent risk factors for AAC, while high RRF is a protective factor. The lateral abdominal X-ray plain film is an inexpensive, simple and promising tool for assessment of AAC, even though its prognostic value of PD patients requires more follow-up studies.     

Risk factors for progression of aortic arch calcification in patients on maintenance hemodialysis

Objective To investigate the possible risk factors for the progression of abdominal aortic calcification (AAC) in MHD patients. Methods Total of 170 patients on MHD between June 2014 and October 2014 in the dialysis center of the Second Hospital of Tianjin Medical University were included prospectively. Lateral lumbar radiography were applied to evaluate patients' AAC score (AACs) at baseline and after two-years of follow-up respectively. According to the change of AACs, the patients were divided into rapid AAC progression group and non-rapid AAC progression group. Multivariable Logistic regression models were used to determine the risk factors for the progression of AAC in MHD patients. Results At baseline, the presence of AAC (AACs≥1) was 43.5%(74/170). The mean follow-up duration was 27.6(24.7, 28.0) months. AACs were available in 111 patients, and the presence of AAC was 78.4%(87/111). During the follow up, 36 patients developed new AAC; rapid AAC progression was seen in 54 patients, and non-rapid AAC progression was seen in 57 patients. Multivariate Logistic regression analysis demonstrated that hyperphosphatemia (OR=4.373,95%CI 1.562-7.246, P=0.005) and high density lipoprotein (HDL) (OR=0.031, 95%CI 0.003-0.338, P=0.004)were independent risk factors for AAC progression in MHD patients. Conclusions Hyperphosphatemia and low HDL may promote the progression of AAC. Well-controlled serum phosphate and lipid metabolism may slow the progression of vascular calcification, reducing cardiovascular morbidity and mortality.     

Relationship between abdominal aortic calcification and outcomes in maintenance hemodialysis patients

Objective To investigate the relationship between abdominal aortic calcification (AAC) and outcomes in maintenance hemodialysis (MHD) patients. Methods One hundred and seventy MHD patients in the dialysis center of the Second Hospital of Tianjin Medical University from June 2014 and October 2014 were enrolled prospectively. Abdominal aortic calcification (AAC) was measured using AAC score (AACS) by abdominal lateral plain radiography. According to the AACS, the patients were divided into mild AAC (AACS＜5) group and severe AAC (AACS≥5) group for comparison, and Kaplan-Meier analysis was used to compare their survival rates. Multivariable COX regression models were used to determine the risk factors of all - cause mortality and cardiovascular disease mortality in MHD patients. Results Severe AAC (AACS≥5) was present in 28.2% (48/170) patients. The median follow-up duration was 25.6 (22.0, 26.0) months. During the follow-up, 6 patients (4.9%) in AACS＜5 group and 14 patients (29.2%) in AACS≥5 group died. Kaplan-Meier analysis showed that patients in AACS≥5 group had higher all-cause mortality rate and cardiovascular disease mortality rate as compared with patients in AACS＜5 group (χ2=9.746,P=0.002; χ2=9.697,P=0.002). Multivariate COX regression analysis demonstrated that high AACS (HR=4.373, 95%CI 1.562-7.246, P=0.005) and hypoproteinemia (HR=0.886, 95% CI 0.797 - 0.985, P=0.025) were independent risk factors for all-cause mortality, while hypoproteinemia (HR=0.829, 95%CI 0.718-0.956, P=0.010) and low 1,25(OH)D3 (HR=0.769, 95% CI 0.627 - 0.944, P=0.012) were independent risk factors for cardiovascular disease mortality. Conclusions AAC is significantly associated with overall survival in MHD patients. To further evaluate the relationship between AAC and outcomes in MHD patients, multi-center and long term follow up studies of large sample size are necessary.     

Effects of abdominal aortic calcification progression on outcomes in maintenance hemodialysis patients

Objective To investigate the effects of abdominal aortic calcification (AAC) progression on outcomes in maintenance hemodialysis (MHD) patients. Methods Patients who were on MHD between Jun. 2014 and Oct. 2014 in the dialysis center of the Second Hospital of Tianjin Medical University and finished the AAC examination at baseline and two years later were included prospectively. The progression of AAC by AAC score (AACs) at baseline and two years later was evaluated. According to the change of AACs, the patients were divided into rapid AAC progression group and non-rapid AAC progression group. The effect of AAC progression on outcomes in MHD patients in the follow-up period was investigated. Kaplan-Meier analysis was used to compare their survival rates. Multivariable Cox regression model was used to determine the risk factors of all-cause mortality, cardiovascular mortality and cardiovascular events. Results A total of 111 MHD patients were included, including 51 males and 60 females, aged (52.24±12.69) years. Baseline AAC prevalence was 45.9% (51/111), and median AACs was 0 (0, 5); After 2 years, the prevalence of AAC was 78.4% (87/111), and the median AACs was 6 (2, 11). There were 54 cases in the AAC rapid progression group (AACs change value＞2) and 57 cases in the non-rapid AAC progression group (AACs change value≤2). The median follow-up duration was 27.9(27.1, 28.0) months. Kaplan-Meier analysis showed that patients in rapid AAC progression group had a higher risk of mortality as compared to patients in non-rapid AAC progression group (Log-rank χ2=5.695, P=0.017). Multivariate Cox regression analysis demonstrated that high baseline AACs (HR=1.135, 95%CI 1.001-1.286, P=0.048), hypoalbuminemia (HR=0.789, 95%CI 0.640-0.972, P=0.026) were independent risk factors for all-cause mortality in MHD patients. High baseline AACs (HR=1.187, 95%CI 1.038-1.356, P=0.012), low spKt/V (HR=0.103, 95%CI 0.013-0.801, P=0.030) were independent risk factors for cardiovascular mortality in MHD patients. Low spKt/V (HR=0.018, 95%CI 0.003-0.115, P＜0.001), hypoalbuminemia (HR=0.736, 95%CI 0.608-0.890, P=0.002) were independent risk factors for cardiovascular events in MHD patients. Conclusions Abdominal aortic calcification progression may increase the risk of cardiovascular events and death in MHD patients. Severity of AAC, adequacy of dialysis, and nutritional status are predictors of outcomes in MHD patients.     

维持性血液透析患者缺血修饰白蛋白水平与腹主动脉钙化相关性分析

目的 研究维持性血液透析(maintenance hemodialysis,MHD)患者中缺血修饰白蛋白(ischemia-modified albumin,IMA)水平及其相关因素,并分析IMA与腹主动脉钙化(ab-dominal aortic calcification,AAC)的关系.方法 选取2016年1月至2...     

Association of serum sclerostin level with mineral disorder and bone density in patients on maintenance hemodialysis

Objective To explore the relationship between serum sclerostin level, and mineral metabolism, bone density, abdominal aortic calcification in maintenance hemodialysis (MHD) patients. Methods Serum sclerostin levels from 175 cases of MHD patients were measured by ELISA. Calcaneus bone mineral density (BMD) was measured by quantitative ultrasound (QUS). The abdominal aortic calcification was detected by abdomen lateral plain radiographs. Interrelations among above parameters were examined statistically. Results The median sclerostin concentration of 175 patients was 160.50(100.67, 256.39) pmol/L. Serum sclerostin levels were correlated positively with age, BMI, serum calcium and serum 25(OH)-vitamin D, while negatively with spKt/v and serum iPTH. In multiple regression analysis, serum sclerostin levels were associated significantly and independently with age, sex, BMI and serum iPTH. Compared to patients with normal BMD (T score≥-1s), the patients with low BMD (T score<-1s) had lower serum sclerostin level [142.97(99.52, 226.02) vs 201.13(107.40, 327.84) pmol/L, P=0.035]. Serum sclerostin levels were correlated significantly and positively with calcaneus BMD. Multivariate logistic regression analysis showed that serum sclerostin level was an independent protective factor for low BMD in MHD patients[OR=0.241, 95%CI (0.078, 0.749), P=0.014]. Conclusions Serum sclerostin levels are associated with mineral disorder and bone density. Sclerostin may become a promising marker of bone turnover in MHD patients.     

Association between serum elastin-derived peptides and abdominal aortic calcification in peritoneal dialysis patients: a cross-sectional study

BackgroundPeritoneal dialysis (PD) patients experience accelerated arterial aging, which is characterized by elastin degradation. Elastin-derived peptides (EDPs) are direct products of elastin fragmentation. This study tried to explore the association between serum EDPs and abdominal aortic calcification (AAC) in PD patients.MethodsSerum levels of EDPs were analyzed in 126 eligible PD patients and 30 controls. PD patients were grouped according to the annularity of AAC evaluated by an abdominal computed tomography (CT) scan. Serum EDPs were analyzed in relation to the presence of AAC or severe AAC in PD patients by logistic regression analysis.ResultsSerum EDPs in PD patients were significantly higher than age-matched controls. In 126 PD patients, higher EDPs was associated with greater risk of present AAC (OR = 1.056, 95%CI 1.010–1.103) and severe AAC (OR = 1.062, 95%CI 1.004–1.123). A combination of EDPs substantially improved the accuracy of diagnostic performance for AAC and severe AAC.ConclusionsEDPs can predict the presence and extent of AAC in PD patients, indicating its possible role to recognize PD patients at risk for AAC and severe AAC.     

Association of vascular calcification,fetuin A,C - reaction protein and the influence on cardiovascular events in peritoneal dialysis patients

ObjectiveTo investigate the association of vascular calcification, fetuin A and C- reaction protein (CRP), and explore the influence on cardiovascular events. MethodsSixty peritoneal dialysis (PD) patients were enrolled in this study. Carotid intima-media thickness (cIMT), fetuin A and CRP, along with the other serum related parameters were detected to find out their influence on vascular calcification in PD patients. The relationship between cIMT, fetuin A, CPR and cardiovascular events was analyzed in PD patients with 18 months followed-up. ResultsOf the 60 PD patients, carotid intima-media thickness (cIMT) was increased in 38 patients(63.3%). Compared with the non-increased cIMT patients, serum fetuin A concentration was significantly decreased(P＜0.05), CRP(P＜0.01) and calcium × phosphate products(P＜0.05) were significantly increased in the high - increased cIMT group. Compared with the low - increased cIMT patients, fetuin A concentration was obviously lower(P＜0.05) and calcium×phosphate products were obviously higher(P＜0.05) in the high- increased cIMT group. Linear regression analysis discovered an obvious negative correlation between CRP and fetuin A(R 2＝0.629,F ＝47.522, P＜0.01) , as well as fetuin A and calcium×phosphate products (R 2＝0.299, F ＝11.948, P＝0.002). Multiple regression analysis indicated that fetuin A was independently negatively correlated with cIMT(B ＝-0.019,t ＝-6.042, P＜0.01). At 18 months, there were 36 newly - happened cardiovascular events and among which 6 cases died. Logistic regression analysis found that increased cIMT was risk factor to cardiovascular events in PD patients(OR ＝3.691， 95%CI 1.467-9.258，P＝0.006). ConclusionDecreased fetuin A and increased calcium×phosphate products deteriorate carotid calcification in PD patients. Micro-inflammation of PD patients represented by high CRP levels may increase calcium×phosphate products by depressing the fetuin A level, and in the end will stimulate carotid calcification. Increased cIMT is a risk factor for cardiovascular events.     

骨硬化蛋白与维持性血液透析患者冠状动脉钙化的关系

Objective To evaluate the potential association of serum sclerostin with the development of coronary artery calcifications(CAC)in maintenance hemodialysis (MHD) patients. Methods Ninety-two patients who were on MHD between Jan 2014 and Jan 2015 in the dialysis center were enrolled prospectively. Serum sclerostin was tested. CAC was measured by multi-slice computed tomography (MSCT) scanning, and the CAC score (CACs) was calculated. Logistic regression analysis was used to determine the risk factor of CAC in MHD patients. The diagnostic value of serum sclerostin for CAC was assessed using receiver operator characteristic curve (ROC). Results CAC (Agatston score>100) was present in 65.2% (60/92) patients, the median CAC score was 446 (26, 1 000). The median of serum sclerostin levels was 37.05 (29.99, 49.04) ng/L. The serum sclerostin levels were significantly elevated in the group of CACs＞400 compared to that in the group of CACs＜100 [40.71(36.69, 74.21) ng/L vs 28.16 (25.27, 33.64) ng/L, P＜0.05]. Multivariate logistic regression analysis showed that serum sclerostin level was independent risk factor for CAC (OR=1.292, 95%CI 1.017-1.641, P＜0.05). The area under the ROC curve (AUC) of serum sclerostin for CAC was 0.846 (95%CI 0.717-0.975, P=0.001), sensitivity was 0.826, and specificity was 0.769 for a cutoff value of 35.165 ng/L. Conclusions Serum sclerostin level is associated with CAC. Serum sclerostin level may have a diagnostic value for CAC in MHD patients.     

Relationship between low vitamin D level and metabolic syndrome in maintenance hemodialysis patients

Objective To evaluate the relationship between low vitamin D level and metabolic syndrome (MS) in maintenance hemodialysis (MHD) patients. Methods A total of 143 patients who had received MHD from Jan 2016 to Jan 2017 in the dialysis center of our hospital were enrolled. Their clinical and laboratory data were collected. The serum 25(OH)D3 levels were measured by chemiluminescence instrument. According to the levels of 25(OH)D3, patients were divided into three groups: sufficient group (＞30 μg/L), insufficient group (15-30 μg/L) and deficient group (＜15 μg/L) to explore how the 25(OH)D3 were associated with MS and abnormal metabolic parameters, including central obesity, raised triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), raised systolic blood pressure (SBP), raised diastolic blood pressure (DBP) and increased fasting blood glucose (FBG). The risk factors of MS and abnormal metabolic factors were analyzed by multivariate logistic regression model. Results Among the 143 MHD patients, the median of serum 25(OH)D3 was 24.30(12.90, 29.50) μg/L and the prevalence of MS was 45.45%(65 cases). Among 3 groups the prevalence of MS, the abdominal circumference and the serum TG showed statistical differences, and they increased with the severity of 25(OH)D3 deficiency (all P＜0.05). The body mass indexes of patients in the insufficient and deficient groups were elevated compared with that in the sufficient group (all P＜0.05). SBP, TG and FBG in deficient group were significantly higher but HDL-C was lower than those in the other two groups (all P＜0.05). The more abnormal metabolism existed, the lower 25(OH)D3 levels patients had (H=61.316, P＜0.001). Multivariate logistic regression analysis showed that in MHD patients low 25(OH)D3 negatively correlated with MS (OR=0.889, 95%CI 0.846-0.934, P＜0.001) and abnormal metabolic factors central obesity (OR=0.913, 95%CI 0.874-0.953, P＜0.001), raised TG (OR=0.932, 95%CI 0.894-0.971, P=0.001), reduced HDL-C (OR=0.901, 95%CI 0.845-0.959, P=0.001), raised SBP (OR=0.898, 95%CI 0.847-0.953, P＜0.001) and raised FBG (OR=0.956, 95%CI 0.920-0.994, P=0.024). Conclusions The prevalence of MS is high in MHD patients and low levels of 25(OH)D3 may be an independent risk factor for MS and abnormal metabolic factors.     

维持性血液透析患者心血管钙化的发生率及相关因素

目的 探讨维持性血液透析患者心血管钙化的发生率及相关因素.方法 选择接受维持性血液透析≥3月的非住院患者60例,完善相关实验室检查,腹部侧位X线片检测腹主动脉钙化评分(Kauppila法),心脏超声检测心脏瓣膜钙化情况,并计算心血管钙化指数.结果 本组患者影像学检查可见钙化的总发生率为68.3％,腹主动脉钙化的患者中5≤腹主动脉钙化评分＜ 16者占41.4％,瓣膜钙化以主动脉瓣为主(占64.5％).有钙化组与无钙化组患者的年龄、血钙、心血管钙化指数存在差异(均P ＜0.05),而透析龄(月)、身高、体质量、握力、血磷、血红蛋白、血清总蛋白、血清白蛋白、血脂未见差异(均P≥0.05).结论 本组患者心血管钙化部位不均衡,随患者年龄和血钙水平的增加,心血管钙化的发生风险升高.     

Fibroblast Growth Factor 23 is a Predictor of Aortic Artery Calcification in Maintenance Hemodialysis Patients

Background: Our study aimed to investigate the factors associated with elevated plasma FGF23 (cFGF23) levels in maintenance hemodialysis (MHD) patients and to determine whether plasma FGF23 level is related to aortic artery calcification (AAC). Methods: This study included 120 MHD patients and 20 controls. The FGF23 level was measured using a C-terminal assay and AAC was detected by a lateral lumbar X-ray plain. Results: Plasma FGF23 levels were significantly higher among dialysis patients compared to controls: FGF23 level of 27691.42 ± 55646.41 RU/mL in MHD patients versus 49.89 ± 23.94 RU/mL in health people. Significant correlations were observed between FGF23 levels and vintage, intact parathyroid hormone (iPTH), serum phosphate, total calcium, 25(OH)D, urea nitrogen (BUN), and serum creatinine (SCR). Stepwise multiple regression analysis showed that the independent parameters associated with FGF23 level were serum phosphate, total calcium, parathyroid hormone (PTH), SCR, and prealbumin. There were 73 patients (60.83%) with visible calcification in the abdominal aorta. Bivariate analysis showed that AAC score correlated with FGF23, phosphate, total calcium, vintage, age, and diastolic blood pressure. Forward logistic analysis showed that the independent parameters associated with AAC were age, total protein, and Lg FGF23. Conclusion: Plasma FGF23 level is significant increased in hemodialysis patients and is independently associated with AAC.     

中晚期CKD患者腹主动脉钙化发生情况及危险因素分析

目的：分析中晚期CKD患者腹主动脉钙化的发生情况和危险因素。方法：63例透析及非透析CKD患者进行腹部侧位片的检查,分析腹主动脉钙化发生情况及影响因素。结果：中晚期CKD患者腹主动脉钙化发生率为54%;腹主动脉钙化与年龄、血磷水平、钙磷乘积和低密度脂蛋白水平呈正相关（P〈0.05）。结论：中晚期CKD患者腹主动脉钙化高发,远端起病,年龄、血脂、钙磷水平影响其程度。     

腹膜透析患者腹主动脉钙化与外周血淋巴细胞亚群的相关研究

目的 探讨腹膜透析(peritoneal dialysis,PD)患者腹主动脉钙化(abdominal aortic calcification,AAC)与外周血淋巴细胞亚群之间的关系.方法 收集86例PD患者临床资料,腹部侧位平片判断患者发生AAC的程度,并计算腹主动脉钙化积分(AAC score,AACs),依据患...     

Multicenter study on the influencing factors of interdialysis blood pressure variability in maintenance hemodialysis patients

Objective To assess the influencing factors of interdialysis blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients from Pearl River Delta, and provide clinically useful information for the prevention and treatment of BPV. Methods MHD patients in 10 hemodialysis centers from Pearl River Delta were enrolled and analyzed retrospectively. According to the quartile of interdialysis systolic blood pressure-coefficient of variation (SBP-CV), patients were divided into four groups, and clinical data, biochemical indicators and drug use were compared among 4 groups. Binary logistic regression analysis was used to analyze the associated factors of interdialysis BPV. Results A total of 1010 MHD patients (612 males and 398 females) with the age of (56.3±13.9) years were enrolled in this study. Their dialysis duration was (48.4±36.1) months, and the median of interdialysis SBP-CV was 8.07% (5.72%, 11.34%). According to the quartile of SBP-CV, the patients were divided into four groups: low BPV group (SBP-CV≤5.72%, 253 cases), middle BPV group (5.72%＜SBP-CV≤8.07%, 252 cases), high BPV group (8.07%＜SBP-CV≤11.34%, 253 cases) and extremely high BPV group (SBP-CV＞11.34%, 252 cases), and the dialysis duration, diabetes, ultrafiltration, interdialysis weight gain rate (IDWGR), serum calcium and the proportion of calcium channel antagonist used in the 4 groups were significantly different (all P＜0.05). Logistic multiple regression analysis showed that high IDWGR (OR=1.216, 95%CI 1.108-1.435, P＜0.001) was an independent risk factors for interdialysis BPV in MHD patients, while high ultrafiltration volume (OR=0.436, 95%CI 0.330-0.575, P＜0.001) and calcium channel antagonists used (OR=0.686, 95%CI 0.477-0.986, P=0.042) were independent protective factors. Conclusion High IDWGR is an independent risk factor for interdialysis BPV in MHD patients, while high ultrafiltration volume and calcium channel antagonists used are protective factors for interdialysis BPV in MHD patients.     

维持性血液透析患者血清胱抑素C与细胞因子及颈动脉病变的关系

目的 研究维持性血液透析（MHD）患者的血清胱抑素C（半胱氨酸蛋白酶抑制剂,CysC）水平的变化及其与细胞因子及颈动脉病变的关系。 方法 选择透析龄超过6个月的MHD患者110例（MHD组）和健康对照组60例为对象。用免疫透射比浊法检测CysC;超声检查颈动脉病变的程度;检测高敏C反应蛋白（hsCRP）、总同型半胱氨酸（tHcy）、血清白介素1β（IL-1β）、IL-6、肿瘤坏死因子α（TNF-α）水平。分析CysC水平与细胞因子及颈动脉病变的关系。 结果 MHD组血清CysC水平为（6.19±0.95） mg/L,显著高于健康对照组的（0.76±0.21） mg/L（P < 0.01）。MHD组hsCRP、tHcy、IL-1β、IL-6、TNF-α水平均显著高于健康对照组（P < 0.05或<0.01）。MHD组患者颈动脉内膜中层厚度（IMT）及斑块形成、颈动脉硬化的患病率均显著高于健康对照组（P < 0.05或P < 0.01）。直线相关分析显示,MHD组血CysC水平与hsCRP、tHcy、IL-1β、IL-6、TNF-α、IMT及斑块形成、颈动脉硬化的患病率呈正相关;与透析龄、收缩压、iPTH亦呈正相关（P < 0.05或P < 0.01）。多因素逐步回归分析显示,CysC、hsCRP、tHcy和年龄是MHD患者颈动脉病变的危险因素。 结论 血液透析不能有效清除CysC等大分子物质,随着透析龄的增加,MHD患者血清CysC水平逐渐升高。CysC与hsCRP等微炎性反应指标及tHcy、颈动脉病变呈正相关,血清CysC水平升高可能是MHD患者并发动脉粥样硬化的危险因素之一。