Tirmenstajn-Jankovic Biserka, Dimkovic Nada, Radojicic Zoran, Bastac Dusan, Zivanovic Milenko, Zikic Svetlana
Department of Nephrology and Hemodialysis, General Hospital, Health Center Zajecar, Zajecar, Serbia.
Clinical Department for Renal Disease, Zvezdara University Medical Center, Belgrade, Serbia.
Saudi J Kidney Dis Transpl. 2017 Jul-Aug;28(4):818-829.
Age is an important risk factor for cardiovascular disease in the general population and in dialysis patients. The aim of this study is to investigate the influence of age on the cardiovascular status of asymptomatic predialysis patients with chronic kidney disease (CKD). Echocardiography and carotid ultrasound were performed in 61 patients with CKD stages 4-5, who were divided by age into two groups: group 1 (≥65 years, n = 31) and group 2 (<65 years, n = 30). Data were compared with those of control group (≥65 years, n = 20). Group 1 patients had significantly higher left ventricular mass index (LVMI), (P <0.001), worse LV diastolic function (lower E/A ratio: P<0.05, E' velocities: P< 0.001, E'/A' ratio: P <0.001, and a higher ratio E/E': P <0.05) and a higher prevalence of aortic (P <0.01) and mitral calcification (P <0.001) compared to group 2 patients. Elderly patients also had significantly increased intima-media thickness (IMT, P <0.001) and a greater prevalence of carotid plaques (P <0.05) and calcifications (P <0.001) than younger patients. Multiple regression analysis showed that IMT, LVMI, and E/A ratio were independent variables associated with aging (R2 = 0.605). We concluded that older CKD patients demonstrated more profound structural and functional abnormalities of the myocardium, as well as more prominent vascular changes compared to younger CKD patients. The changes in IMT, LVMI, and E/A ratio are independently associated with aging of CKD patients.
年龄是普通人群和透析患者心血管疾病的重要危险因素。本研究旨在调查年龄对无症状慢性肾脏病（CKD）透析前患者心血管状况的影响。对61例CKD 4-5期患者进行了超声心动图和颈动脉超声检查，这些患者按年龄分为两组：第1组（≥65岁，n = 31）和第2组（<65岁，n = 30）。将数据与对照组（≥65岁，n = 20）的数据进行比较。与第2组患者相比，第1组患者的左心室质量指数（LVMI）显著更高（P <0.001），左心室舒张功能更差（E/A比值更低：P<0.05，E'速度：P <0.001，E'/A'比值：P <0.001，E/E'比值更高：P <0.05），主动脉钙化（P <0.01）和二尖瓣钙化的患病率更高（P <0.001）。老年患者的内膜中层厚度（IMT，P <0.001）也显著增加，颈动脉斑块（P <0.05）和钙化（P <0.001）的患病率高于年轻患者。多元回归分析显示，IMT、LVMI和E/A比值是与衰老相关的独立变量（R2 = 0.605）。我们得出结论，与年轻的CKD患者相比，老年CKD患者表现出更严重的心肌结构和功能异常，以及更明显的血管变化。IMT、LVMI和E/A比值的变化与CKD患者的衰老独立相关。
