Petrauskiene Vaida, Vaiciuniene Ruta, Bumblyte Inga Arune, Kuzminskis Vytautas, Ziginskiene Edita, Grazulis Saulius, Jonaitiene Egle
Medical academy, Lithuanian University of Health sciences, Eiveniu g. 2A, Kaunas 50009, Lithuania; Nephrology department, Hospital of Lithuanian University of Health sciences Kaunas Clinics, Kaunas 50009, Lithuania.
Medical academy, Lithuanian University of Health sciences, Eiveniu g. 2A, Kaunas 50009, Lithuania; Nephrology department, Hospital of Lithuanian University of Health sciences Kaunas Clinics, Kaunas 50009, Lithuania.
Nephrol Ther. 2016 Dec;12(7):503-507. doi: 10.1016/j.nephro.2016.06.005. Epub 2016 Oct 21.
Vascular calcification (VC) is one of the factors associated with cardiovascular mortality in hemodialysis (HD) patients. Recommendations concerning screening for VC differ. Possible ability to prevent and reversibility of VC are major subjects on debate whether screening for VC could improve outcomes of renal patients. The objective of the study was to evaluate the significance of simple vascular calcification score (SVCS) based on plane radiographic films and to test its association with non-fatal cardiovascular events in patients on chronic HD.
A study population consisted of 95 prevalent HD patients in the HD unit of Hospital of Lithuanian University of Health sciences Kaunas Clinics. Clinical data and laboratory tests information were collected from medical records. SVCS was evaluated as it is described by Adragao et al. After measurement of VC, HD patients were observed for novel non-fatal cardiovascular events.
Patients were divided into two groups: SVCS≥3 (57 patients [60%]) and <3 (38 patients [40%]). The Kaplan-Meier survival curves show a significant difference in non-fatal cardiovascular events in the group with SVCS≥3 vs. <3 group (26.3% vs. 7.8%; log rank 5,49; P=0.018). Multivariate Cox regression analysis confirmed a negative impact of VC, hyperphosphatemia, and lower ejection fraction on cardiovascular events. No statistically significant differences were observed comparing parameters of Ca-P metabolism disorders between groups with different SVCS. On separate analysis, the presence of VC in hands was also associated with higher rate of novel cardiovascular events (score 0 goup-5 events [10.6%] vs. score≥1 group-13 events [27%], log rank P=0.035).
VC assessed by simple and inexpensive radiological method was an independent predictor of novel non-fatal cardiovascular events in HD patients.
血管钙化（VC）是血液透析（HD）患者心血管死亡的相关因素之一。关于VC筛查的建议存在差异。VC的预防可能性和可逆性是关于筛查VC是否能改善肾病患者预后的主要争论话题。本研究的目的是评估基于平面X线片的简单血管钙化评分（SVCS）的意义，并测试其与慢性HD患者非致死性心血管事件的相关性。
研究人群包括立陶宛卫生科学大学考纳斯临床医院HD单元的95例HD患者。从病历中收集临床数据和实验室检查信息。按照阿德拉高等人描述的方法评估SVCS。测量VC后，观察HD患者新发的非致死性心血管事件。
患者分为两组：SVCS≥3（57例[60%]）和<3（38例[40%]）。Kaplan-Meier生存曲线显示，SVCS≥3组与<3组的非致死性心血管事件有显著差异（26.3%对7.8%；对数秩检验5.49；P = 0.018）。多变量Cox回归分析证实，VC、高磷血症和较低的射血分数对心血管事件有负面影响。不同SVCS组之间的钙磷代谢紊乱参数比较未观察到统计学显著差异。单独分析时，手部VC的存在也与新发心血管事件的发生率较高相关（评分为0组-5例事件[10.6%]对评分≥1组-13例事件[27%]，对数秩检验P = 0.035）。
通过简单且廉价的放射学方法评估的VC是HD患者新发非致死性心血管事件的独立预测因素。
