腹膜透析与血液透析患者冠状动脉钙化差异分析

目的:评估腹膜透析及血液透析患者冠状动脉钙化情况,分析其影响因素,并评价两种透析模式冠脉钙化差异。方法:入组血液透析31例,腹膜透析23例,计算冠脉钙化积分,分析其影响因素并比较差异。结果:透析患者冠状动脉钙化发生率为85.19%。血液透析及腹膜透析患者的冠状动脉钙化积分分别为221.14(0~120 055.72)vs 228.79(0~11 096.1),两者差异无统计学意义。冠脉钙化积分在腹膜透析人群中与既往心血管疾病史呈正相关(P=0.001),而在血液透析人群中与碱性磷酸酶(ALP)呈正相关(P=0.003)。多元线性回归提示ALP为冠状动脉钙化的独立危险因素。以冠状动脉钙化积分100为界,钙化程度较重的腹透患者,血甲状旁腺激素、ALP及红细胞水平均较低且具有统计学意义。而钙化程度较重的血透患者,年龄及ALP则显著高于冠脉钙化程度较轻者。结论:ALP是冠状动脉钙化的独立危险因素。腹膜透析合并低ALP患者,以及血液透析合并高ALP患者,冠状动脉钙化风险较高。     

血液透析患者冠状动脉电子束CT扫描钙化积分及其相关因素

目的探讨血液透析患者冠状动脉钙化的相关因素。方法以冠状动脉电子束CT(EBCT)扫描钙化积分确定冠状动脉钙化的程度,回顾性分析心血管疾病的危险因素及钙磷代谢异常等因素对冠状动脉钙化的影响。结果22例维持性血液透析患者进行了EBCT检查,有21例患者(95郾4%)存在不同程度的冠状动脉钙化(EBCT钙化积分>0分),EBCT钙化积分平均1935郾54分(0分～9833分)。EBCT钙化积分≥100分的患者心血管疾病的发病率、血清磷、钙磷乘积和C鄄反应蛋白显著增高而血清白蛋白显著降低(P<0.05)。多元逐步回归分析的结果显示,冠状动脉钙化的影响因素有透析龄和低密度脂蛋白(HDL鄄C)(P<0.05)。结论尿毒症血液透析患者普遍存在冠状动脉钙化,但确切的机制不清楚。冠状动脉钙化(EBCT钙化积分)与高血磷、高钙磷乘积等有关,透析龄、HDL鄄C是冠状动脉钙化的独立影响因素。     

血液透析患者血清FGF23水平的影响因素及其与矿物质骨代谢异常的关系研究

目的分析维持性血液透析患者血清成纤维细胞生长因子23(FGF23)水平的影响因素,并探究其与矿物质骨代谢异常及血管钙化的关系。 方法2018年1月至2月期间纳入在南方医科大学附属东莞市人民医院进行维持性血液透析3个月以上患者380例,记录其性别、年龄、透析龄、透析充分性及降磷药物使用情况。透析前抽取血清检查钙、磷、全段甲状旁腺素(iPTH)及碱性磷酸酶等矿物质骨代谢指标,以及血红蛋白、白蛋白、血糖、血脂、血清超敏C反应蛋白(hs-CRP)、血清β2微球蛋白等指标。使用酶联免疫吸附法(ELISA)检测血清FGF23,多层螺旋CT进行冠状动脉钙化评分(MSCT)。采用t检验和卡方检验对维持性血液透析患者FGF23的影响因素进行单因素分析,之后使用多元线性逐步回归方法进行多因素分析。 结果本中心维持性血液透析患者血清FGF23中位数水平为8 905.3 ng/L,根据患者的FGF23水平50%中位数将患者分为低水平组(组1)和高水平组(组2)两组。单因素分析结果表明,透析龄、每次透析时间、透析超滤量及使用非含钙降磷药物和透析频次为FGF23水平的影响因素。透析龄更大,每次透析时间长,每周透析次数多、透析超滤量大的患者FGF23水平更高(均P<0.05)。在FGF23水平高于中位数的患者中,尿素氮、血肌酐和血清β2微球蛋白水平更高(均P<0.05)。多元线性回归分析显示,透析龄长和血肌酐升高是FGF23升高的危险因素(均P<0.001)。同时,高FGF23水平与血清钙、血清磷、iPTH水平和高冠状动脉钙化评分相关。 结论透析龄、每次透析时间、透析超滤量、透析频次、尿素氮、血肌酐、血清β2微球蛋白水平与维持血液透析患者FGF23升高有关。透析龄长和血肌酐高是FGF23升高的危险因素。FGF23与维持性血液透析患者矿物质骨代谢和冠状动脉钙化明显相关。     

维持性血液透析患者血清FGF23、胎球蛋白A水平与冠状动脉钙化关系的研究

目的:探讨维持性血液透析(MHD)患者血清FGF23、胎球蛋白A(FA)水平及其与冠状动脉钙化的相关性。方法:选择行冠状动脉多层螺旋CT(MSCT)检查的MHD患者89例,根据冠状动脉的Agaston评分(CACs)将患者分为无钙化组(CACs10),轻度钙化组(11CACs100),中度钙化组(101CACs400)和重度钙化组(CACs400)。Spearman线性回归分析MHD患者血清FGF23、FA水平以及冠状动脉钙化的相关危险因素,逐步多元线性回归分析MHD患者冠状动脉钙化的独立危险因素。结果:89例MHD患者中无冠状动脉钙化者18例(20.2%),有冠状动脉钙化(CACs10)者71例(79.8%),其中轻度钙化组(10CACs100)32例(36.0%),中度钙化组(101CACs400)22例(24.7%),重度钙化组(CACs400)17例(19.1%)。Spearman相关回归分析显示,MHD患者冠状动脉钙化程度与年龄、糖尿病、透析龄、血压、CACs、Hs CRP、Ca~(2+)、P~(3-)、Ca~(2+)×P~(3-)、FGF23呈明显正相关(r值分别为0.249,0.283,0.238,0.231,0.724,0.299,0.232,0.371,0.411,0.314,P0.05);与FA、Vit D呈明显负相关(r值分别为-0.309,-0.243),P0.05;与BUN、Scr、e GFR、Hb、Alb、Glu、TC、TG、i PTH和AKP等指标无明显相关,P0.05。血清FGF23浓度与CACs、血P~(3-)、Ca~(2+)×P~(3-)、i PTH水平呈明显正相关(r值分别为0.471,0.312,0.427,0.215),P0.05;血清FA浓度与CACs、CRP水平呈明显正相关(r值分别为0.295,0.269),与Alb浓度呈明显负相关(r值为-0.258),P0.05;逐步多元线性回归分析表明患者的年龄、透析龄、血磷、钙磷乘积、血FGF23和FA水平是影响MHD患者冠脉钙化积分的独立危险因素[OR(95%CI)分别为3.123(2.521~5.363),2.352(1.924~4.631),5.692(3.731~8.265),11.243(9.185~14.836),2.181(1.732~3.463),0.734(0.526~0.912),P0.05]。结论:患者的年龄、透析龄、血磷、钙磷乘积、血FGF23和FA水平是影响MHD患者冠脉钙化积分的独立危险因素。     

维持性血液透析患者主动脉钙化相关影响因素分析

目的：探讨维持性血液透析（MHD）患者主动脉钙化的相关影响因素。方法：采用胸部正位X线成像技术检测183例MHD患者主动脉钙化情况,将入选患者分为主动脉钙化组（A组）和主动脉无钙化组（B组）,透析前抽血检测血钙、血磷、全段甲状旁腺激素（iPTH）、C反应蛋白（CRP）和血清白蛋白（Alb）等指标,并计算钙磷乘积,比较两组年龄、透析龄和血清学指标的差异,将上述指标与主动脉钙化进行相关性分析,并对筛选出来的危险因素进行非条件Logistic回归分析。结果：A组和B组在年龄、透析龄、血磷、钙磷乘积和CRP水平方面,差异均有统计学意义（P〈0.01或P〈0.05）;MHD患者主动脉钙化的相关影响因素包括：年龄、透析龄、血磷、钙磷乘积及CRP;Logistic回归分析表明,年龄、透析龄和血磷是主动脉钙化的独立危险因素（P〈0.01）。结论：MHD患者主动脉钙化相当常见,主动脉钙化与年龄、透析龄、钙磷代谢和炎症状态有关。     

冠状动脉钙化积分、血压变异性与维持性血液透析患者心血管事件的关系

目的:探讨冠状动脉钙化积分、血压变异性与维持性血液透析患者心血管事件的关系。方法:选取2017年7月—2018年12月于我院进行维持性血液透析的患者169例,根据随访期内是否发生主要不良心血管事件(MACE)分为MACE组和非MACE组(NMACE组),比较两组患者一般临床资料、冠状动脉钙化积分和血压变异性的差异,分析冠状动脉钙化积分和血压变异性与MACE的关系。结果:随访时间内,维持性血液透析患者的MACE发生率为42.01%(71/169)。MACE组患者的年龄、透析时间、冠状动脉钙化积分、收缩压变异系数(SBP-CV)及舒张压变异系数(DBP-CV)明显高于NMACE组(均P0.05)。Logistic多因素回归分析显示年龄(OR=1.827)、SBP-CV(OR=1.589)、DBP-CV(OR=1.691)及冠状动脉钙化积分(OR=1.959)均是维持性血液透析患者发生MACE的危险因素(均P0.05)。SBP-CV、DBP-CV和冠状动脉钙化积分诊断维持性血液透析患者发生MACE的ROC曲线下面积(AUC)分别为0.795、0.829、0.847,三者联合诊断的AUC最高(0.952)(均P0.05)。结论:冠状动脉钙化积分和血压变异性对维持性血液透析患者MACE的发生均具有较高的预测价值,二者的联合检测有助于改善患者预后。     

血液透析患者冠状动脉钙化的危险因素

目的 研究血液透析患者冠状动脉钙化情况,并分析其相关危险因素.方法 选择行血液透析治疗的患者201例,横断面调查所有患者血红蛋白、透析前后血清钙、血清磷、血清钾、尿素氮、肌酐、全段甲状旁腺激素、总蛋白、白蛋白、总胆固醇、甘油三酯、C反应蛋白、血清铁、铁蛋白、总铁结合力和冠状动脉钙化情况,分析冠状动脉钙化相关危险因素.结果 201例血液透析患者中发生冠状动脉钙化137例,总钙化发生率为68.2％.冠状动脉钙化组与无钙化组比较,年龄、性别、高血压、糖尿病、收缩压、脉压差、血钾、血磷、Kt/V及腰臀比差异均有统计学意义(P＜0.05).年龄、透析龄、性别、收缩压、脉压差、血钾、血磷为冠状动脉钙化的独立危险因素(P＜0.05);Kt/V为冠状动脉钙化的独立保护因素(P＜0.05).结论 血液透析患者冠状动脉钙化的发生率偏高;年龄、透析龄、性别、收缩压、脉压差、血钾、血磷为冠状动脉钙化的独立危险因素;Kt/V为冠状动脉钙化的独立保护因素.     

终末期肾脏病透析患者骨密度与冠脉钙化的相关性分析

目的探讨终末期肾脏病(end stage renal disease,ESRD)透析患者骨密度与冠状动脉钙化(coronary artery colcification,CAC)之间的相关性。方法本研究为横断面研究。纳入115例ESRD患者,收集相关人口学特征、原发病、实验室检查等资料,双能X射线评估腰椎、股骨颈及髋部骨密度,多层螺旋计算机断层扫描(MSCT)检查患者CAC发生情况。以钙化积分100为界,将患者分为高钙化组和低钙化组。结果高钙化组56例,占维持性透析患者48%,其中男性36例,占高钙化组人数64.3%。高钙化组年龄、透析龄及血清甲状旁腺激素、碱性磷酸酶、25(OH) D水平均明显高于低钙化组,而股骨颈骨密度、髋部骨密度、血清胆固醇水平明显低于低钙化组(P0.05);男性高钙化组股骨颈骨密度及髋部骨密度明显低于低钙化组,且其冠脉钙化积分与股骨颈骨密度(r=-0.34,P0.05)、髋部骨密度(r=-0.65,P0.01)呈负相关。多元线性回归分析校正了年龄、透析龄等因素后仍显示男性髋部骨密度与冠脉钙化积分呈负相关(β=-1870.47,P0.05)。但在女性患者中,高钙化组与低钙化组骨密度无明显差异。结论骨密度降低可能是男性维持性透析患者冠脉钙化风险增高的危险因素。     

维持性透析患者尿酸与冠状动脉钙化的关系

目的:探讨慢性肾脏病5期维持性透析(CKD5D)患者血尿酸水平与冠状动脉(冠脉)钙化的关系。方法:收集我院收治的101例CKD5D患者入组时的一般资料、血生化指标、血红蛋白、全段甲状旁腺素等。采用多层螺旋CT计算冠脉钙化积分,根据血尿酸水平四分位数将患者分为三组,比较各组患者冠脉钙化的发生率及严重程度。Pearson相关分析评估血尿酸与冠脉钙化的相关性,多元线性回归分析评估冠脉钙化的影响因素。结果:(1)本研究101例患者中82例(81. 2%)出现冠脉钙化,中位钙化积分184. 3,重度冠脉钙化(钙化积分 400)的患者比率高达41. 6%。(2)低尿酸组、中等尿酸组、高尿酸组患者冠脉钙化的发生率分别为76. 9%、84%、80%,重度冠脉钙化的发生率分别为46. 2%、38%、44%,组间比较均无显著性差异。(3)单因素分析显示血尿酸水平与冠脉钙化积分不相关,多元线性回归分析示血尿酸对冠脉钙化没有线性影响,但痛风是冠脉钙化的独立影响因素。结论:CKD5D患者冠脉钙化发生率高,钙化程度重。血尿酸水平与冠脉钙化的程度不相关,伴痛风的CKD5D患者发生冠脉钙化的风险增高。     

老年人骨质疏松与冠状动脉硬化关系的初步探讨

目的 探讨老年人骨质疏松与冠状动脉粥样硬化的关系.方法 对64例老年患者进行腰椎骨密度（BMD）的定量CT（QCT）测定判断有无骨质疏松症,运用多排螺旋CT（MSCT）检测冠脉钙化积分和总积分,并通过填写调查表了解患者的一般情况、生活习惯及其他影响冠脉钙化的因素.将所有患者按冠脉钙化总积分值分为TCS＞50组和TCS≤50组,并比较两组的临床数据和骨密度,用Logistic回归方法和偏相关法分析有关因素与冠脉钙化之间的关系.结果 年龄、腰椎BMD、血Ca、TC、TG、HDL两组比较有显著性差异（P＜0.05）,而体重指数、血清LDL、P、ApoA、ApoB等指标,两组间比较,差异无显著性（P＞0.05）.Logistic回归显示：年龄、高密度脂蛋白、吸烟及骨质疏松对冠脉钙化有影响,其中年龄、吸烟及骨质疏松是其独立危险因素,高密度脂蛋白是保护因素,偏相关分析得出骨质疏松与冠脉钙化之间存在正相关,腰椎BMD与冠脉TCS存在负相关关系.结论 老年人骨质疏松与冠状动脉粥样硬化存在一定的相关关系,MSCT检测的TCS可作为反映冠状动脉硬化和骨质疏松关系的参考指标.     

CKD患者冠状动脉钙化的危险因素分析

目的:分析CKD患者冠状动脉钙化与临床指标的相关性,探讨其发生的危险因素。方法:选取473例曾在我院行冠脉CT检查的CKD及非CKD患者,通过收集其生化指标及冠脉CT检查结果,分析CKD患者冠状动脉钙化与临床检查指标的关系。结果:患者冠状动脉钙化积分(CACs)与年龄、尿素氮、肌酐水平、血磷水平和钙磷乘积呈正相关(P<0.05),与肾小球滤过率和血红蛋白呈负相关(P<0.05)。结论:年龄、尿素氮和血磷是患者冠脉发生钙化的独立危险因素,年龄、肌酐水平、肾小球滤过率和血磷水平与冠状动脉钙化严重程度有线性关系。     

Assessment of vascular calcification in ESRD patients using spiral CT.

BACKGROUND: Dialysis patients have increased vascular calcification of the coronary arteries and aorta by electron beam CT scan. The purpose of the present study was to utilize an alternative machine, spiral CT, to assess calcification in end-stage renal disease (ESRD) patients. METHODS: Two groups of patients with ESRD were evaluated: group 1, those receiving a renal transplant (n=38); and group 2, those remaining on dialysis (n=33). All patients underwent quad-slice spiral CT with retrospective gating to evaluate coronary artery and aorta calcification scores. Both area (Agatston method) and volume calculations were utilized, with retrospective gating in all but 16 subjects. Laboratory tests, medications and clinical characteristics were analysed. RESULTS: Using spiral CT, the intra-reader variability for coronary artery calcification (after correction for very low scores) was 0.9% mean / 0% median using the area (Agatston method) and 2.9% mean / 0% median using volume calculations. Group 1 patients were younger, more likely to be Caucasian and on peritoneal dialysis, had lower serum calcium and higher C-reactive protein levels than group 2. In patients without vs those with coronary artery calcification, only longer duration of dialysis (34+/-64 vs 55+/-50 months, P=0.004; r=0.39, P=0.005) and increasing age (39+/-13 vs 54+/-10 years, P<0.001; r=0.29, P=0.039) were associated, whereas only increasing age was associated with aorta calcification. CONCLUSION: In ESRD patients, the factors correlating with coronary calcification were duration of dialysis and advancing age, whereas only age correlated with aorta calcification. Spiral CT offers an alternative technique for the assessment of these changes.     

CKD与非CKD患者冠状动脉钙化发生情况的比较研究

目的:比较CKD患者与非CKD患者的冠状动脉钙化情况。方法:选取473例曾在我院行冠脉CT检查的CKD及非CKD患者,通过收集其生化指标及冠脉CT检查结果,分析并比较两组患者冠状动脉钙化的发生情况。结果:CKD患者冠状动脉钙化的发生率为76.5%,且钙化累及分支更多,LAD、RCA多发。钙化组的尿素氮、血磷水平及钙磷乘积显著高于非钙化组,而GFR则显著低于非钙化组(P<0.01)。结论:CKD患者冠状动脉钙化发生率高,累及范围广,程度更重,且LAD、RCA钙化多发。钙化组的尿素氮、血磷水平及钙磷乘积显著高于非钙化组,而GFR则显著低于非钙化组。     

Coronary calcification in hemodialysis patients: the contribution of traditional and uremia-related risk factors

BACKGROUND: Coronary artery calcification is a common feature of atherosclerosis, occurring in 90% of angiographically significant lesions. There is recent evidence that coronary artery calcification is frequent in hemodialysis patients and it has been suggested that this increased incidence may be associated to uremia-related factors. The development and progression of coronary artery calcification is similar to osteogenesis. The aim of this study was to evaluate the relationship between coronary artery calcification, uremia-related factors, and bone histomorphometry in hemodialysis patients. METHODS: A total of 101 hemodialysis patients were assessed for biochemical markers of inflammation, oxidative stress, and bone metabolism. Subsequently, they were submitted to multislice coronary tomography (MSCT) and transiliac bone biopsy. RESULTS: The median calcium score was 116.2 (range 0 to 5547). Fifty-two percent of the patients showed moderate and severe coronary artery calcification, 20% had calcium scores greater than 1000. In univariate analysis, age (r= 0.57, P < 0.000001), osteoprotegerin (OPG) (r= 0.44, P= 0.00002), and body mass index (BMI) (r= 0.24, P= 0.01) correlated positively with calcium score. Bone trabecular volume and trabecular thickness correlated negatively with calcium score (r=-0.24, P= 0.02; r=-0.22, P= 0.03). There was a correlation of borderline significance between calcium score and C-reactive protein (CRP) (r= 0.18, P= 0.062). The multiple linear regression analysis identified OPG as the only variable independently associated with coronary artery calcification. CONCLUSION: Coronary artery calcification is highly prevalent in the hemodialysis population and is associated with older age, higher BMI, inflammation and reduced trabecular bone volume. Higher OPG is independently associated with coronary artery calcification and may represent an incomplete self-defensive response to the progression of atherosclerosis in hemodialysis patients.     

Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients

BACKGROUND: Cardiovascular event is the major cause of mortality in patients on maintenance hemodialysis. We prospectively tested the predictive values of atherosclerotic parameters for all-cause and cardiovascular outcomes in 219 hemodialysis patients (age, 58 +/- 13 years; time on hemodialysis, 13 +/- 7 years; male/female, 144/75). METHODS: We measured blood homocysteine (Hcy), ultrasound carotid artery intima media thickness (IMT) and % aortic wall calcification at L2/3 region [% of calcification index in the abdominal aortic wall (%ACI)] by computed tomography (CT) scan, and followed all patients for 5 years. RESULTS: During the follow-up periods, 54 patients (25%) died, 40 (74%) of them of cardiovascular causes. IMT was significantly higher in patients who expired (0.75 +/- 0.02 mm) than in those who survived (0.62 +/- 0.01 mm). IMT was significantly correlated with age (r = 0.47, P < 0.01) and %ACI (r = 0.27, P < 0.01). The survival rate during the observation was significantly lower in the final IMT third (58%) than in the first (90%) and the middle IMT third (80%) (P < 0.01). Multivariate Cox proportional hazards analysis revealed that diabetes and IMT became independent determinants of all-cause and cardiovascular death. Adjusted hazards ratios of all-cause and cardiovascular mortality for an increase of 0.1 mm in IMT were 1.31 (95% CI, 1.07 to 1.59) and 1.41 (95% CI, 1.12 to 1.76). In contrast, %ACI at abdominal aorta and blood Hcy did not affect their 5-year mortality. CONCLUSION: These findings suggested that measurement of carotid artery IMT is useful for predicting long-term mortality in patients receiving maintenance hemodialysis.     

冠状动脉钙化对维持性血液透析患者心脏结构和功能的影响及其相关因素评估

目的 观察冠状动脉钙化（CAC）对维持性血液透析（MHD）患者心脏结构和功能的影响，探讨引起CAC的相关危险因素。 方法 40例MHD患者经螺旋CT扫描，了解合并CAC的患者比例，并计算其钙化积分以评估CAC程度。应用心脏彩超和颈动脉超声检查心脏形态、功能及颈动脉斑块，进一步分析MHD患者各项临床指标与CAC的关系。 结果 25例MHD患者（62.5%）合并不同程度的CAC，平均钙化积分为672.3。钙化组（CAC组）与无钙化组（NCAC组）心脏形态及左室顺应性、颈动脉内膜中层厚度（IMT）、斑块发生率、斑块积分差异均有统计学意义。缺血性心脏病和心衰竭发生率均以CAC组为高。4例死于心脏疾病患者均存在CAC。颈动脉斑块阳性组IMT平均为（0.86±0.15） mm，钙化发生率为81%，冠状动脉钙化积分为867±198，均明显高于斑块阴性组[分别为（0.73±0.14） mm,42%,437±176,P < 0.05]。CAC组年龄、糖尿病或肥胖患者比例、透析时间、血磷、C反应蛋白（CRP）、胆固醇和低密度脂蛋白水平、钙磷乘积、颈动脉IMT、斑块积分均高于NCAC组。多元逐步回归分析显示，年龄、透析时间与CAC密切相关。 结论 MHD患者普遍存在CAC。CAC与心脏结构、功能的变化及颈动脉粥样硬化相关。糖尿病及肥胖患者比例、钙磷代谢及脂代谢异常、透析时间、CRP、动脉粥样硬化是CAC的相关因素。年龄和透析时间是CAC的独立危险因素。     

Intracranial artery calcification in hemodialysis patients

Intracranial artery calcification is an independent risk factor for ischemic stroke, and while it is frequently observed on computed tomographic images of the brain in hemodialysis patients, its distribution has not been well studied. Fifty patients on maintenance hemodialysis were enrolled in this study. We divided the patients with intracranial artery calcification into two groups according to the duration of maintenance hemodialysis and compared the frequency of intracranial calcification of each of the intracranial arteries between the two groups. Intracranial artery calcification was found in 36 of the 50 hemodialysis patients. Among the 36 patients with intracranial artery calcification, the prevalence of calcification of each of the arteries was as follows: vertebral artery, 58.3%; internal carotid artery, 61.1%; basilar artery, 41.7%; anterior cerebral artery, 16.7%; middle cerebral artery, 30.6%; posterior cerebral artery, 8.3%. The prevalence of calcification of each of the intracranial arteries did not differ significantly between the patients with a hemodialysis duration of more than 20 years and those less than 20 years. The most frequently involved site of calcification was the internal carotid artery. The prevalence of calcification of the other intracranial arteries, particularly of the basilar artery, were relatively high. The prevalence of calcification of each of the intracranial arteries did not differ significantly between the patients with a hemodialysis duration of more than 20 years and less than 20 years.     

Assessment of frailty and its influence factors in maintenance hemodialysis patients

Objective To investigate the frailty in maintenance hemodialysis (MHD) patients and its influence factors. Methods A total of 127 adults undergoing hemodialysis from January 2015 and January 2016 in our center were recruited. Their clinical data and blood biochemical data were collected. Frailty was assessed using Fried's Frailty Phenotype. Quantification of coronary artery calcification (CACs) was determined by multi-slice spiral computed tomography (MSCT). According to the frailty scores, patients were divided into non-frailty, pro-frailty and frailty group. Their in clinical and biochemical index as well as CACs were compared. The correlations of frailty scores with above index were assessed by Spearman's correlation. Multiple logistic regression analysis was applied to evaluate the effect factors of frailty on MHD patients. Results Among 127 selected patients, 46(36.22%) patients without frailty, 45(35.43%) patients with pro-frailty, and 36(28.35%) patients with frailty. The age, diabetes, haemoglobin, albumin, pre-albumin, C-reactive protein, fibroblast growth factor 23 (FGF23), CACs and left ventricular end-diastolic dimension (LVEDD) of the 3 groups had statistical differences (all P＜0.05). The degrees of calcification among 3 groups were also different statistically (F=31.769, P＜0.001). In patients with MHD, frailty was positively correlated with age (r=0.545, P＜0.001), diabetes (r=0.236, P=0.008), C-reactive protein (r=0.245, P=0.006), FGF23 (r=0.189, P=0.034) and CACs (r=0.396, P＜0.001), while negatively correlated with haemoglobin (r=-0.257, P=0.004), albumin (r=-0.380, P＜0.001), pre-albumin (r=-0.313, P＜0.001). Age (OR=1.076), C-reactive protein (OR=1.176), albumin (OR=0.796) and artery calcification (OR=2.465) were independent influence factors for frailty in MHD patients (all P＜0.05). Conclusions The prevalence of frailty is high among MHD patients. Frailty is associated with age, C-reactive protein, albumin and artery calcification in MHD patients.