Centre of Nephrology, Vilnius University Hospital Santaros Clinics, Santariskiu street 2, LT-08661, Vilnius, Lithuania.
Centre of Endocrinology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
Aging Clin Exp Res. 2018 Apr;30(4):375-382. doi: 10.1007/s40520-017-0787-7. Epub 2017 Jun 28.
Vascular calcification is one of the risk factors for arterial stiffness in patients with chronic kidney disease. We hypothesized that a mismatch between elastic and muscular arteries, represented as pulse wave velocity (PWV) ratio, could depict the extent of vascular calcification in end-stage renal disease. We also aimed to compare the predictive PWV ratio value to other factors possibly related to vascular calcification in dialysis population.
In this cross-sectional study, in 60 chronic dialysis patients without previous cerebrovascular events, cardiovascular disease and events or clinically evident peripheral artery disease (ankle-brachial index >0.9), carotid-femoral and carotid-radial PWV as well as central hemodynamic parameters were measured by applanation tonometry (SphygmoCor). The PWV ratio using carotid-femoral PWV divided by carotid-radial PWV was calculated. Each patient underwent blood tests and chest X-ray for aortic arch calcification scoring. Two experienced radiologists blinded to patient's medical data evaluated chest X-rays (Cohen's kappa coefficient 0.76) and calculated how many sectors were calcified (Ogawa et al. in Hemodial Int 13:301-306, 2009). Differently scored chest X-rays were repeatedly reviewed and a consensus was reached.
The study population consisted of 31 (51.7%) males and 29 (48.3%) females, mean age 52.73 ± 13.76 years. Increased risk for aortic arch calcification was associated with higher PWV ratio even after adjustment for age, height, heart rate, ferritin level and C-reactive protein level (OR 2.59E+04, 95% CI 2.43E+01, 2.65E+09, p = 0.021). PWV ratio together with above-mentioned variables could predict the presence of aortic arch calcification with specificity of 93% (95% CI 78, 99%) and sensitivity of 53% (95% CI 34, 72%).
The elastic and muscular arteries' stiffness mismatch was strongly associated with the extent of aortic arch calcification in this dialysis population and had better calcification predictive value compared to other demographic, hemodynamic and biochemical markers.
血管钙化是慢性肾脏病患者动脉僵硬的一个危险因素。我们假设弹性和肌性动脉之间的不匹配，表现为脉搏波速度（PWV）比值，可以描述终末期肾病患者血管钙化的程度。我们还旨在比较预测 PWV 比值与透析人群中可能与血管钙化相关的其他因素。
在这项横断面研究中，我们测量了 60 名无先前脑血管事件、心血管疾病和事件或临床明显外周动脉疾病（踝臂指数>0.9）的慢性透析患者的颈股和颈桡 PWV 以及中心血流动力学参数，使用平板测压法（SphygmoCor）。计算颈股 PWV 除以颈桡 PWV 的 PWV 比值。每位患者均接受血液检查和胸部 X 射线检查以进行主动脉弓钙化评分。两名经验丰富的放射科医生对患者的医疗数据进行盲法评估，计算有多少个区域钙化（Ogawa 等人，Hemodial Int 13:301-306, 2009）。不同评分的胸部 X 射线被重复审查并达成共识。
研究人群包括 31 名（51.7%）男性和 29 名（48.3%）女性，平均年龄为 52.73±13.76 岁。即使在调整年龄、身高、心率、铁蛋白水平和 C 反应蛋白水平后，较高的主动脉弓钙化风险与较高的 PWV 比值相关（比值比 2.59E+04，95%置信区间 2.43E+01，2.65E+09，p=0.021）。PWV 比值与上述变量一起可以预测主动脉弓钙化的存在，特异性为 93%（95%置信区间 78, 99%），敏感性为 53%（95%置信区间 34, 72%）。
在这个透析人群中，弹性和肌性动脉的僵硬不匹配与主动脉弓钙化的程度密切相关，与其他人口统计学、血流动力学和生化标志物相比，具有更好的钙化预测价值。
