Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA.
Kidney Int. 2010 Jun;77(12):1107-14. doi: 10.1038/ki.2010.70. Epub 2010 Mar 17.
Vascular calcification is one of the mechanisms mediating the higher mortality risk associated with the hyperphosphatemia of chronic kidney disease. Though common, and often severe in non-dialyzed proteinuric diabetics, there are no studies on the prognostic significance of coronary artery calcification in early stage type 2 diabetic nephropathy. Here we determine this significance in 225 proteinuric diabetic patients (mean age 57 years, mean estimated glomerular filtration rate (eGFR) 52 ml/min per 1.73 m(2) and a median urine protein-creatinine ratio of 2.7). Coronary artery calcification, measured by electron beam computed tomography, was diagnosed in 86% of the patients, the severity of which correlated with older age, male gender, and white ethnicity. However, no association was found between eGFR, serum calcium, phosphorus, parathyroid hormone, or 25-hydroxy vitamin D. Over an average follow-up of 39 months, 54 patients died. A graded relationship between the severity of calcification and all-cause mortality was consistently demonstrated on both univariate and multivariate analyses. Patients in the highest quartile of calcification score had a 2.5-fold higher risk for death. Our results show the severity of coronary artery calcification early in the course of chronic kidney disease is an independent predictor of all-cause mortality. Additional studies need to determine whether altering the natural history of coronary artery calcification in early chronic kidney disease prolongs survival.
血管钙化是导致慢性肾脏病高磷血症患者死亡率升高的机制之一。虽然在非透析蛋白尿型糖尿病患者中较为常见且通常较为严重，但目前尚无研究探讨早期 2 型糖尿病肾病患者冠状动脉钙化的预后意义。在此，我们对 225 例蛋白尿型糖尿病患者（平均年龄 57 岁，平均估算肾小球滤过率（eGFR）为 52ml/min/1.73m2，尿蛋白/肌酐比值中位数为 2.7）进行了研究。采用电子束计算机断层扫描（EBCT）诊断冠状动脉钙化，86%的患者存在冠状动脉钙化，其严重程度与年龄较大、男性和白种人有关。然而，eGFR、血清钙、磷、甲状旁腺激素或 25-羟维生素 D 与冠状动脉钙化之间无相关性。在平均 39 个月的随访期间，54 例患者死亡。无论是单因素还是多因素分析，都一致显示出钙化严重程度与全因死亡率之间呈分级关系。钙化评分最高四分位的患者死亡风险增加 2.5 倍。我们的研究结果表明，慢性肾脏病早期冠状动脉钙化的严重程度是全因死亡率的独立预测因素。需要进一步的研究来确定是否可以改变早期慢性肾脏病患者冠状动脉钙化的自然病程，从而延长其生存期。
