Schwaiger J P, Neyer U, Sprenger-Mähr H, Kollerits B, Mündle M, Längle M, Kronenberg F
Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Innsbruck Medical University, Innsbruck, Austria.
Kidney Int. 2006 Aug;70(3):543-8. doi: 10.1038/sj.ki.5001589. Epub 2006 Jun 14.
Vascular calcifications are very common in dialysis patients and have been shown to be associated independently with outcome. However, all of these studies used prevalent patients on dialysis since many years. We investigated vascular calcifications in an inception cohort of dialysis patients and followed them for cardiovascular disease outcomes during an average observation period of 66 months. One hundred and fifty-four Caucasian dialysis patients were enrolled in one Austrian dialysis center. Standardized plain radiographs from the pelvis and calves were carried out in all patients at the start of dialysis therapy. Vascular calcifications were assessed by a single radiologist. At the start of renal replacement therapy, 67.5% of the patients showed vascular calcifications. During follow-up, 29.9% of patients suffered a cardiovascular event. An additive 'vascular risk score', constructed from the presence of vascular calcifications and/or previous cardiovascular events before the start of dialysis treatment, showed the strongest independent association with cardiovascular events in the Cox regression model adjusted for various risk factors. The presence of each of these two conditions was associated with a hazard ratio of 2.03 (95% confidence interval 1.19-3.46) and a hazard ratio twice as high if both conditions were present. In summary, vascular calcifications on plain X-rays of pelvis and calves are largely present in incident dialysis patients. A history of a cardiovascular event in the predialysis period together with vascular calcifications at the beginning of dialysis therapy is a more powerful predictor of a cardiovascular event than age, smoking, diabetes, or other traditional risk factors.
血管钙化在透析患者中非常常见，并且已被证明与预后独立相关。然而，所有这些研究都使用了多年来一直在透析的现患患者。我们在一组初诊透析患者中调查了血管钙化情况，并在平均66个月的观察期内对他们进行心血管疾病预后随访。154名白种人透析患者在奥地利的一个透析中心入组。在透析治疗开始时，对所有患者进行骨盆和小腿的标准化平片检查。血管钙化由一名放射科医生评估。在肾脏替代治疗开始时，67.5%的患者出现血管钙化。在随访期间，29.9%的患者发生了心血管事件。根据透析治疗开始前血管钙化的存在情况和/或既往心血管事件构建的累加“血管风险评分”，在针对各种风险因素进行调整的Cox回归模型中显示与心血管事件的独立关联最强。这两种情况中的每一种的存在都与风险比2.03（95%置信区间1.19 - 3.46）相关，如果两种情况都存在，风险比则高出两倍。总之，骨盆和小腿的X线平片上的血管钙化在初诊透析患者中大量存在。透析前期的心血管事件史以及透析治疗开始时的血管钙化比年龄、吸烟、糖尿病或其他传统风险因素更能有力地预测心血管事件。
