Fox Caroline S, Larson Martin G, Vasan Ramachandran S, Guo Chao-Yu, Parise Helen, Levy Daniel, Leip Eric P, O'donnell Christopher J, D'Agostino Ralph B, Benjamin Emelia J
National Heart, Lung and Blood Institute's Framingham Heart Study, 73 Mount Wayte Avenue, Framingham, MA 01702, USA.
J Am Soc Nephrol. 2006 Feb;17(2):521-7. doi: 10.1681/ASN.2005060627. Epub 2005 Dec 28.
Valvular calcification is common in the setting of end-stage kidney disease and is associated with increased risks for cardiovascular disease events. It is unknown whether the prevalence of valvular calcification is increased in milder kidney disease after accounting for cardiovascular risk factors. Participants who attended the sixth examination of the Framingham Offspring Study (1995 to 1998) were eligible. Kidney function was estimated by GFR using the simplified Modification of Diet in Renal Disease Study equation. Mitral annular calcification (MAC), aortic sclerosis, and aortic annular calcification were assessed by two-dimensional echocardiography. Logistic regression was used to examine the odds of valvular calcification among participants with chronic kidney disease (CKD; GFR < 60 ml/min per 1.73 m(2)). A total of 3047 participants (52% women; mean age 59 +/- 10 yr) were available for analysis. CKD was present in 8.6% (n = 262) of the sample. Among participants with valve/annular calcification (n = 284; 9.3%), 20% had CKD, compared with 7% in patients without valvular calcification. After adjustment for age, gender, systolic and diastolic BP, hypertension treatment, total/HDL cholesterol, body mass index, diabetes, smoking status, and cardiovascular disease, participants with CKD had a 60% increased odds of MAC (odds ratio 1.6; 95% confidence interval 1.03 to 2.5). There was no significant association between CKD and either aortic sclerosis or aortic annular calcification (odds ratio 1.1 and 1.1, respectively). After age and gender adjustment, the combination of both CKD and MAC was associated with a three-fold increased risk for death compared with those with neither condition (P = 0.0004). In the community, CKD is associated with presence of MAC before the onset of ESRD. Further research is warranted to understand whether traditional and novel vascular risk factor burden, as well as metabolic derangements found in early kidney disease, can account for the CKD-MAC association.
瓣膜钙化在终末期肾病患者中很常见，并且与心血管疾病事件风险增加相关。在考虑心血管危险因素后，轻度肾病患者的瓣膜钙化患病率是否增加尚不清楚。参加弗雷明汉心脏研究后代队列第六次检查（1995年至1998年）的参与者符合条件。使用简化的肾脏病饮食改良研究方程通过肾小球滤过率（GFR）估算肾功能。通过二维超声心动图评估二尖瓣环钙化（MAC）、主动脉硬化和主动脉环钙化。采用逻辑回归分析慢性肾脏病（CKD；GFR<60 ml/min/1.73 m²）参与者瓣膜钙化的比值比。共有3047名参与者（52%为女性；平均年龄59±10岁）可供分析。样本中8.6%（n = 262）存在CKD。在有瓣膜/环钙化的参与者中（n = 284；9.3%），20%患有CKD，而无瓣膜钙化患者中这一比例为7%。在调整年龄、性别、收缩压和舒张压、高血压治疗、总胆固醇/高密度脂蛋白胆固醇、体重指数、糖尿病、吸烟状况和心血管疾病后，CKD参与者发生MAC的比值比增加60%（比值比1.6；95%置信区间1.03至2.5）。CKD与主动脉硬化或主动脉环钙化之间无显著关联（比值比分别为1.1和1.1）。在调整年龄和性别后，与既无CKD也无MAC的参与者相比，同时患有CKD和MAC的参与者死亡风险增加两倍（P = 0.0004）。在社区中，CKD与终末期肾病发作前MAC的存在相关。有必要进一步研究以了解传统和新型血管危险因素负担以及早期肾病中发现的代谢紊乱是否能够解释CKD与MAC之间的关联。
