Avila Marcela, Mora Carmen, Prado María Del Carmen, Zavala Miriam, Paniagua Ramón
Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN SXXI, Instituto Mexicano del Seguro Social, Mexico, Mexico.
Am J Nephrol. 2017;46(1):39-46. doi: 10.1159/000477380. Epub 2017 Jun 15.
Arterial calcification (AC) is frequent in patients with end stage renal disease and is also considered a risk factor for later morbidity and mortality. However, long-term factors associated with the process are not well known. We analyzed the trends over time of biomarkers related with development and progression of AC in incident patients on peritoneal dialysis (PD).
We performed a prospective study with 186 patients on PD followed up for 1 year. We analyzed the progression of AC in the abdominal aorta and pelvic vessels by calcification score (CaSc), using16-cut computerized multidetector tomography at baseline and 1 year. Variables related with PD treatment, inflammation, and mineral metabolism were measured at baseline, 6, and 12 months of follow-up. Changes in biochemical variables were analyzed for their relationship with changes in AC.
Over 1 year, the number of patients with AC increased from 47 to 56%, and CaSc from 355 (interquartile range [IQR] 75-792) to 529 (IQR 185-1632). A total of 43.5% of patients remained free of calcification, 11.7% had new calcifications, and 44.8% had progression of calcification. Older age, diabetes, high systolic blood pressure, body mass index, cholesterol, and osteoprotegerin (OPG), as well as lower levels of albumin, serum creatinine, and osteocalcin, were associated with development of new, and rapid progression of, calcification. In multivariate logistic analysis, OPG remained the most significant (OR 1.27, 95% CI 1.11-1.47, p < 0.001).
OPG was the strongest risk factor associated with new development and rapid progression of AC in incident PD patients.
动脉钙化（AC）在终末期肾病患者中很常见，并且也被认为是后期发病和死亡的危险因素。然而，与该过程相关的长期因素尚不清楚。我们分析了腹膜透析（PD）初治患者中与AC发生和进展相关的生物标志物随时间的变化趋势。
我们对186例接受PD治疗的患者进行了为期1年的前瞻性研究。我们在基线和1年时使用16层计算机断层扫描通过钙化评分（CaSc）分析腹主动脉和盆腔血管中AC的进展情况。在随访的基线、6个月和12个月时测量与PD治疗、炎症和矿物质代谢相关的变量。分析生化变量的变化与AC变化之间的关系。
在1年期间，AC患者的数量从47%增加到56%，CaSc从355（四分位间距[IQR]75 - 792）增加到529（IQR 185 - 1632）。共有43.5%的患者无钙化，11.7%有新的钙化，44.8%有钙化进展。年龄较大、糖尿病、收缩压高、体重指数、胆固醇和骨保护素（OPG），以及较低水平的白蛋白、血清肌酐和骨钙素，与新钙化的发生和快速进展相关。在多因素逻辑分析中，OPG仍然是最显著的因素（比值比1.27，95%置信区间1.11 - 1.47，p < 0.001）。
OPG是与PD初治患者AC新发生和快速进展相关的最强危险因素。
