Department of Nephrology, The Second Affiliated Hospital of GuangZhou Medical University , Guangzhou , China .
Ren Fail. 2014 Feb;36(1):65-8. doi: 10.3109/0886022X.2013.832309. Epub 2013 Sep 13.
Serum fetuin A has been shown to be associated with the risk of vascular calcification and atherosclerosis, and it can predict the onset of cardiovascular mortality in dialysis patients. The carotid intima-media thickness (cIMT) is an accessible and reliable method to identify the subclinical atherosclerosis. The aim of this study was to investigate the relationships between dialysate calcium concentrations and fetuin A or cIMT in patients undergoing peritoneal dialysis (PD). Forty patients, newly diagnosed end-stage renal disease (ESRD) and undergoing peritoneal dialysis, were enrolled in the study, with a calcium content of the peritoneal dialysis (PD) solution of 1.25 mmol/L in 20 patients (low-Ca group) and 1.75 mmol/L in 20 patients (standard-Ca group). The patients were followed up for 12 months after the PD conducted. Serum fetuin A was determined using a human fetuin A enzyme-linked immunosorbent assay kit and cIMT was detected using ultrasonic wave. We observed no difference between two groups with regard to the baseline data of fetuin A, cIMT, calcium, phosphorus, calcium-phosphorus product, high sensitivity CRP (hsCRP), parathyroid hormone (PTH), or lipid parameters. After 12 months follow-up, fetuin A (263.92 ± 16.1 vs. 282.76 ± 21.0, p = 0.017) and calcium-phosphorus product (39.85 ± 7.76 vs. 47.50 ± 6.65, p = 0.009) were obviously lower in the low-Ca group than standard-Ca group, the other serum parameters were not different between these two groups. Compared with baseline data, serum fetuin A concentration significantly reduced in low-Ca group ( p < 0.05). The number of patients with increased cIMT and newly occurring cardiovascular events in the low-Ca group were significantly reduced than standard-Ca group ( p < 0.05). In conclusion, our data suggest that low calcium dialysate treatment is associated with the decreased serum fetuin A concentration and serum calcium-phosphorus product, and it is associated with the reduced number of PD patients with increased cIMT or with newly occurring cardiovascular events. However, more studies with lager sample size should be performed in the future.
血清胎球蛋白 A 与血管钙化和动脉粥样硬化的风险相关，并且可以预测透析患者心血管死亡率的发生。颈动脉内膜中层厚度 (cIMT) 是一种可用于识别亚临床动脉粥样硬化的可及且可靠的方法。本研究的目的是探讨腹膜透析 (PD) 患者中透析液钙浓度与胎球蛋白 A 或 cIMT 之间的关系。40 名新诊断为终末期肾脏疾病 (ESRD) 并接受腹膜透析的患者入组本研究，其中 20 名患者腹膜透析液中钙含量为 1.25mmol/L（低钙组），20 名患者腹膜透析液中钙含量为 1.75mmol/L（标准钙组）。在 PD 治疗后，患者进行了 12 个月的随访。使用人胎球蛋白 A 酶联免疫吸附测定试剂盒测定血清胎球蛋白 A，使用超声波检测 cIMT。两组间胎球蛋白 A、cIMT、钙、磷、钙磷乘积、高敏 C 反应蛋白 (hsCRP)、甲状旁腺激素 (PTH) 或血脂参数的基线数据无差异。经过 12 个月的随访，低钙组的胎球蛋白 A（263.92±16.1 vs. 282.76±21.0，p=0.017）和钙磷乘积（39.85±7.76 vs. 47.50±6.65，p=0.009）明显低于标准钙组，其他血清参数在两组间无差异。与基线数据相比，低钙组血清胎球蛋白 A 浓度显著降低（p<0.05）。低钙组 cIMT 增加和新发生心血管事件的患者数量明显少于标准钙组（p<0.05）。总之，我们的数据表明，低钙透析液治疗与血清胎球蛋白 A 浓度和血清钙磷乘积降低有关，与腹膜透析患者 cIMT 增加或新发生心血管事件的患者数量减少有关。然而，未来需要进行更多具有更大样本量的研究。
