Lumlertgul Dusit, Kantachuvesiri Surasak, Apichaiyingyurd Somboon, Treamtrakanpon Worapot, Rattanasompattikul Manoch, Gojaseni Pongsathorn, Thanakitcharu Prasert, Trakarnvanich Thananda, Poonvivatchaikarn Ussanee, Vareesangthip Kriengsak
Renal Division, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Renal Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Ther Apher Dial. 2017 Dec;21(6):611-619. doi: 10.1111/1744-9987.12581. Epub 2017 Oct 4.
Presence and severity of cardiovascular calcifications strongly predict cardiovascular morbidity and mortality in patients with CKD. This multicenter, cross-sectional study primarily aimed to determine prevalence of abdominal aortic calcification (AAC) detected by plain lateral abdominal radiograph, and secondarily aimed to assess predictive factors for AAC. Patients (N = 1500), aged 18-70 years, with CKD stages 3-5D for ≥3 months prior to evaluation, were enrolled at 24 study centers in Thailand; 54.3% were non-dialysis patients. The prevalence of AAC was 70.6% and 70.8% in non-dialysis and dialysis patients, respectively. Patient's advanced age and widening pulse pressure were identified as predictive factors for AAC ≥ 5 in non-dialysis patients, while patient's age, history of coronary heart disease or diabetes, longer dialysis vintage, and increasing corrected serum calcium or high-sensitivity C-reactive protein were identified as such in dialysis patients. With additional regression having covariates in binary, corrected serum calcium ≥9.5 mg/dL gave an OR 1.974 (95% CI: 1.324-2.943) for AAC ≥ 5 among the dialysis patients. AAC in diabetes subgroup (N = 692) was additionally evaluated and found that it was prevalent at 84.7% with increased phosphorus as predictive factor (OR, 1.178; 95% CI: 1.032-1.344) and 1,25 (OH) vitamin D as protective factor (OR, 0.983; 95% CI, 0.970-0.996). The prevalence of AAC in the Thai CKD population is lower than that reported in the literature, and yet the burden is prominent in patients coexisting with diabetes. Variable relationships identified in this study may guide preventive measures against cardiovascular complications in CKD patients.
心血管钙化的存在及严重程度可有力预测慢性肾脏病（CKD）患者的心血管发病率和死亡率。这项多中心横断面研究主要旨在确定通过腹部侧位平片检测到的腹主动脉钙化（AAC）的患病率，其次旨在评估AAC的预测因素。年龄在18 - 70岁、评估前CKD 3 - 5D期≥3个月的患者（N = 1500）在泰国的24个研究中心入组；54.3%为非透析患者。非透析患者和透析患者的AAC患病率分别为70.6%和70.8%。在非透析患者中，患者高龄和脉压增宽被确定为AAC≥5的预测因素，而在透析患者中，患者年龄、冠心病或糖尿病史、透析时间延长以及校正血清钙或高敏C反应蛋白升高被确定为预测因素。在二元回归中加入协变量后，校正血清钙≥9.5mg/dL在透析患者中对于AAC≥5的比值比为1.974（95%可信区间：1.324 - 2.943）。对糖尿病亚组（N = 692）的AAC进行了额外评估，发现其患病率为84.7%，磷升高为预测因素（比值比，1.178；95%可信区间：1.032 - 1.344），而1,25（OH）维生素D为保护因素（比值比，0.983；95%可信区间，0.970 - 0.996）。泰国CKD人群中AAC的患病率低于文献报道，但在合并糖尿病的患者中负担仍然突出。本研究确定的多种关系可能指导CKD患者心血管并发症的预防措施。
