Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Nephrol Dial Transplant. 2011 May;26(5):1662-9. doi: 10.1093/ndt/gfq582. Epub 2010 Sep 29.
Previous studies have shown that simple imaging methods may be useful for detection of vascular calcifications in dialysis patients. Based on annual, plain chest X-rays during follow-up on dialysis, we studied the associations of mineral metabolism with the presence and progression of aortic calcification. In addition, we assessed the impact of aortic calcification on mortality.
Three hundred and eighty-four patients who started haemodialysis or peritoneal dialysis between 1997 and 2007 were included (age 61 ± 15 years, 64% male, 61% haemodialysis). Annual chest X-rays were screened for calcification in the aortic arch, and patients were categorized as having no, moderate or severe calcification. Progression was defined as an increase in calcification category during follow-up on dialysis.
At baseline, 96 (25%) patients had severe, 205 (53%) patients had moderate and 83 (22%) patients had no aortic calcification. For 237 of the 288 patients with no or moderate calcifications at baseline, X-rays were available for follow-up. During follow-up (mean 2.3 years), aortic calcification progressed in 71 patients (30%). We found that baseline plasma calcium > 9.5 mg/dL and iPTH > 300 pg/mL were associated with progression [odds ratios of 3.1, 95% confidence interval (1.2-8.2) and 4.4 (1.4-14.1), respectively]. Progression of aortic calcification was significantly associated with increased risk of all-cause mortality (hazard ratio: 1.9; 95% CI: 1.2-3.1) and cardiovascular mortality (hazard ratio: 2.7; 95% CI: 1.3-5.6).
Aortic calcification progressed in almost a third of the patients during dialysis. Hypercalcaemia and hyperparathyroidism were associated with an increased risk of progression. Progression of aortic calcification was significantly related to an increased mortality risk.
既往研究表明，简单的影像学方法可能有助于检测透析患者的血管钙化。基于透析期间每年的常规胸部 X 光片，我们研究了矿物质代谢与主动脉钙化的存在和进展之间的关系。此外，我们评估了主动脉钙化对死亡率的影响。
纳入 1997 年至 2007 年间开始血液透析或腹膜透析的 384 例患者（年龄 61 ± 15 岁，64%为男性，61%为血液透析）。每年对胸部 X 射线进行筛查，以确定主动脉弓是否存在钙化，并将患者分为无钙化、中度钙化或重度钙化。进展定义为在透析期间随访过程中钙化程度增加。
基线时，96 例（25%）患者有严重钙化，205 例（53%）患者有中度钙化，83 例（22%）患者无主动脉钙化。在基线时无或中度钙化的 288 例患者中，有 237 例患者的 X 射线可供随访。在随访期间（平均 2.3 年），71 例（30%）患者的主动脉钙化进展。我们发现，基线时血浆钙>9.5mg/dL 和 iPTH>300pg/mL 与进展相关[比值比分别为 3.1（95%置信区间为 1.2-8.2）和 4.4（1.4-14.1）]。主动脉钙化的进展与全因死亡率（危险比：1.9；95%置信区间：1.2-3.1）和心血管死亡率（危险比：2.7；95%置信区间：1.3-5.6）的增加显著相关。
在透析期间，近三分之一的患者的主动脉钙化进展。高钙血症和甲状旁腺功能亢进症与进展风险增加相关。主动脉钙化的进展与死亡率风险的增加显著相关。
