Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Nephrol Dial Transplant. 2009 Dec;24(12):3826-33. doi: 10.1093/ndt/gfp325. Epub 2009 Jul 2.
It remains unknown whether a composite of inflammation and calcification markers provides better mortality and cardiovascular risk stratification in chronic peritoneal dialysis (PD) patients.
We performed a 4-year prospective follow-up study in 231 chronic PD patients from a single regional dialysis centre in Hong Kong. Valvular calcification was detected using echocardiography, and fasting venous blood was collected to measure a panel of inflammation markers. The patients were stratified into five groups on the basis of 0, 1, 2, 3 and all 4 inflammation and calcification risk markers, namely high C-reactive protein (CRP) (CRP in upper tertile), high interleukin-6 (IL-6) (IL-6 in upper tertile), low fetuin-A (fetuin-A in lower tertile) and valvular calcification. Study outcomes included all-cause and cardiovascular mortality and fatal or non-fatal cardiovascular events (CVEs).
The patients with 4, 3, 2 and 1 markers had an adjusted hazard ratio (HR) of 5.17 (95% CI, 1.81-14.77, P = 0.002), 3.38 (95% CI, 1.50-7.60; P = 0.003), 2.17 (95% CI, 0.98-4.77; P = 0.056) and 2.42 (95% CI, 1.18-4.96; P = 0.016), respectively, for mortality at 4 years than those with 0 risk marker. The adjusted HRs for fatal or non-fatal CVEs were 4.33 (95% CI, 1.70-11.03; P = 0.002), 1.60 (95% CI, 0.73-3.52; P = 0.24), 1.92 (95% CI, 0.95-3.90; P = 0.07) and 1.33 (95% CI, 0.67-2.62; P = 0.42), respectively, for patients with 4, 3, 2 and 1 markers than those with 0 risk markers.
A composite of inflammation and calcification markers provides long-term prognostication and identifies the sickest PD patients with the worst clinical outcomes. Since these parameters can all be obtained quite readily, our data support the adoption of a multiinflammation and calcification risk marker approach for mortality and cardiovascular risk stratification in PD patients.
目前尚不清楚炎症和钙化标志物的综合指标是否能更好地预测慢性腹膜透析（PD）患者的死亡率和心血管风险分层。
我们对来自香港某单一地区透析中心的 231 例慢性 PD 患者进行了为期 4 年的前瞻性随访研究。使用超声心动图检测瓣膜钙化，采集空腹静脉血检测炎症标志物。根据是否存在 4 种炎症和钙化风险标志物（高 C 反应蛋白（CRP）（CRP 在最高三分位）、高白细胞介素-6（IL-6）（IL-6 在最高三分位）、低胎球蛋白-A（胎球蛋白-A 在最低三分位）和瓣膜钙化），将患者分为 5 组。研究结局包括全因死亡率、心血管死亡率和致死性或非致死性心血管事件（CVE）。
存在 4、3、2 和 1 种标志物的患者，其 4 年时的调整后的危险比（HR）分别为 5.17（95%CI，1.81-14.77，P=0.002）、3.38（95%CI，1.50-7.60；P=0.003）、2.17（95%CI，0.98-4.77；P=0.056）和 2.42（95%CI，1.18-4.96；P=0.016）。存在 4 种标志物的患者，其发生致死性或非致死性 CVE 的调整后的 HR 为 4.33（95%CI，1.70-11.03；P=0.002），而存在 1 种标志物的患者为 1.60（95%CI，0.73-3.52；P=0.24），存在 0 种标志物的患者为 1.92（95%CI，0.95-3.90；P=0.07），存在 2 种标志物的患者为 1.33（95%CI，0.67-2.62；P=0.42）。
炎症和钙化标志物的综合指标可提供长期预后信息，并识别出临床结局最差的最病重 PD 患者。由于这些参数都很容易获得，因此我们的数据支持采用多炎症和钙化风险标志物方法对 PD 患者进行死亡率和心血管风险分层。
