老年人肾功能与心脏钙化的关联：心血管健康研究
Association of renal function with cardiac calcifications in older adults: the cardiovascular health study.
作者信息
Asselbergs Folkert W, Mozaffarian Dariush, Katz Ronit, Kestenbaum Bryan, Fried Linda F, Gottdiener John S, Shlipak Michael G, Siscovick David S
机构信息
Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
出版信息
Nephrol Dial Transplant. 2009 Mar;24(3):834-40. doi: 10.1093/ndt/gfn544. Epub 2008 Oct 7.
BACKGROUND
Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are highly prevalent in patients with end-stage renal disease. It is less well established whether milder kidney disease is associated with cardiac calcifications. We evaluated the relationships between renal function and MAC, aortic annular calcification (AAC) and AVS in the elderly.
METHODS
From the Cardiovascular Health Study, a community-based cohort of ambulatory adults >or= age 65, a total of 3929 individuals (mean +/- SD age 74 +/- 5 years, 60% women) were evaluated with two-dimensional echocardiography. Renal function was assessed by means of creatinine-based estimated glomerular filtration rate (eGFR) and cystatin C.
RESULTS
The prevalences of MAC and AAC were significantly higher in individuals with an eGFR < 45 mL/ min/1.73 m(2) (P < 0.01 for each), and cystatin C levels were significantly higher in individuals with MAC or AAC compared to individuals without these cardiac calcifications (P < 0.001 for each). After multivariate-adjustment, an eGFR <45 mL/min/1.73 m(2) was significantly associated with MAC [odds ratio 1.54 (95% CI 1.16-2.06), P = 0.003] and not associated with AAC [1.30 (0.97-1.74), P = 0.085] and AVS [1.15 (0.86-1.53), P = 0.355]. In addition, cystatin C levels were independently associated with MAC [odds ratio per SD 1.12 (1.05-1.21), P = 0.001] and not associated with AAC [1.07 (1.00-1.15), P = 0.054] and AVS [0.99 (0.93-1.06), P = 0.82]. Furthermore, the prevalence of multiple cardiac calcifications was higher in subjects with an eGFR < 45 mL/ min/1.73 m(2) and increased per quartile of cystatin C (P-values < 0.001). In addition, a significant trend was observed between an eGFR < 45 mL/min/1.73 m(2), increasing levels of cystatin C and the number of cardiac calcifications (P < 0.05).
CONCLUSIONS
In a community-based cohort of the elderly, moderate kidney disease as defined by an eGFR <45 mL/min/1.73m(2) and elevated levels of cystatin C was associated with prevalent MAC. In addition, a significant trend was observed between an eGFR <45 mL/min/1.73m(2), increasing levels of cystatin C and the number of cardiac calcifications. No associations were found between renal function and AAC or AVS.
背景
主动脉瓣硬化（AVS）和二尖瓣环钙化（MAC）在终末期肾病患者中极为常见。轻度肾病是否与心脏钙化相关，目前尚不明确。我们评估了老年人肾功能与MAC、主动脉瓣环钙化（AAC）及AVS之间的关系。
方法
在心血管健康研究中，对一个以社区为基础的65岁及以上非卧床成年人队列进行研究，共有3929人（平均年龄74±5岁，60%为女性）接受了二维超声心动图检查。通过基于肌酐的估计肾小球滤过率（eGFR）和胱抑素C评估肾功能。
结果
eGFR<45 mL/min/1.73 m²的个体中MAC和AAC的患病率显著更高（每项P<0.01），与无这些心脏钙化的个体相比，有MAC或AAC的个体胱抑素C水平显著更高（每项P<0.001）。多变量调整后，eGFR<45 mL/min/1.73 m²与MAC显著相关[比值比1.54（95%CI 1.16 - 2.06），P = 0.003]，与AAC[比值比1.30（0.97 - 1.74），P = 0.085]和AVS[比值比1.15（0.86 - 1.53），P = 0.355]无关。此外，胱抑素C水平与MAC独立相关[每标准差比值比1.12（1.05 - 1.21），P = 0.001]，与AAC[比值比1.07（1.00 - 1.15），P = 0.054]和AVS[比值比0.99（0.93 - 1.06），P = 0.82]无关。此外，eGFR<45 mL/min/1.73 m²的受试者中多种心脏钙化的患病率更高，且随胱抑素C四分位数增加而升高（P值<0.001）。此外，在eGFR<45 mL/min/1.73 m²、胱抑素C水平升高与心脏钙化数量之间观察到显著趋势（P<0.05）。
结论
在一个以社区为基础的老年人群队列中，eGFR<45 mL/min/1.73m²和胱抑素C水平升高所定义的中度肾病与MAC患病率相关。此外，在eGFR<45 mL/min/1.73m²水平、胱抑素C水平升高与心脏钙化数量之间观察到显著趋势。未发现肾功能与AAC或AVS之间存在关联。
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