Srivaths Poyyapakkam, Krishnamurthy Rajesh, Brunner Lori, Logan Barbara, Bennett Michael, Ma Qing, VanDeVoorde Rene, Goldstein Stuart L
Department of Pediatrics, Renal Section, Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX, and Cincinnati Children's Hospital Medical Center, Section of Nephrology and Hypertension, Cincinnati, OH, USA.
Clin Nephrol. 2014 Apr;81(4):231-7. doi: 10.5414/cn108178.
Children receiving maintenance dialysis exhibit high cardiovascular (CV) associated mortality. We and others have shown high prevalence of cardiac calcifications (CC) in children with endstage renal disease (ESRD). However, no pediatric study has examined modality difference in CC prevalence. The current study was conducted to assess for a difference in CC prevalence between hemodialysis (HD) and peritoneal dialysis (PD) in children with ESRD.
38 patients (19 female, 19 male; mean age 15.5 ± 4.1 years) receiving dialysis (21 HD, 17 PD) were included in the study. CC were assessed by ultrafast gated CT and quantified by Agatston score. Patients received thrice weekly HD for 3 - 3.5 hours or daily continuous cycler PD (CCPD). FGF 23, IL-6, IL-8, and CRP levels were obtained at time of CT. Time-averaged (6 months prior to CT) serum Ca, P, Alb, iPTH, and cholesterol levels were obtained. Patients on aspirin, with evidence of infection, underlying collagen vascular disease were excluded.
CC were present in 11/38 patients, but more prevalent in HD vs. PD (9/21 vs. 2/17, p = 0.04). Subjects with CC were older (p = 0.0003), had longer dialysis vintage (p = 0.02) and higher serum phosphorus (p = 0.02) and FGF 23 levels (p = 0.03). HD patients also had significantly higher phosphorus (p = 0.02), FGF 23 (p = 0.009), and IL-8 levels (p = 0.02) when compared to PD patients. Residual renal function was not different between modalities or patients with CC. On a multinomial regression model, modality, and age remained independent associations for CC prevalence.
We have shown that pediatric patients receiving CCPD have lower CC prevalence conferring lower CV risk. The better control of mineral imbalance in patients receiving PD may play an important role in lower CC prevalence.
接受维持性透析的儿童心血管相关死亡率较高。我们及其他研究表明，终末期肾病（ESRD）患儿心脏钙化（CC）的患病率很高。然而，尚无儿科研究探讨CC患病率在不同透析方式间的差异。本研究旨在评估ESRD患儿血液透析（HD）和腹膜透析（PD）的CC患病率差异。
本研究纳入了38例接受透析治疗的患者（19例女性，19例男性；平均年龄15.5±4.1岁）（21例HD，17例PD）。通过超快门控CT评估CC，并采用阿加斯顿评分进行量化。患者每周接受3次HD，每次3 - 3.5小时，或每日接受持续循环腹膜透析（CCPD）。在CT检查时获取FGF 23、IL - 6、IL - 8和CRP水平。获取时间平均（CT检查前6个月）血清钙、磷、白蛋白、iPTH和胆固醇水平。排除正在服用阿司匹林、有感染证据、患有潜在胶原血管疾病的患者。
38例患者中有11例存在CC，但HD患者的CC患病率高于PD患者（9/21 vs. 2/17，p = 0.04）。存在CC的患者年龄更大（p = 0.0003），透析时间更长（p = 0.02），血清磷（p = 0.02）和FGF 23水平更高（p = 0.03）。与PD患者相比，HD患者的磷（p = 0.02）、FGF 23（p = 0.009）和IL - 8水平也显著更高。不同透析方式之间以及存在CC的患者之间，残余肾功能无差异。在多项回归模型中，透析方式和年龄仍然是CC患病率的独立相关因素。
我们已经表明，接受CCPD的儿科患者CC患病率较低，心血管风险也较低。接受PD治疗的患者对矿物质失衡的更好控制可能在降低CC患病率方面发挥重要作用。
