Division of Nephrology, Malatya Education and Research Hospital, Malatya, Turkey.
Division of Biochemistry, Faculty of Medicine, Inonu University, Malatya, Turkey.
Int Urol Nephrol. 2018 Jan;50(1):137-142. doi: 10.1007/s11255-017-1740-6. Epub 2017 Nov 13.
Vascular calcification (VC) in hemodialysis (HD) patients is a sign of severe cardiovascular disease and can predict cardiovascular outcomes. Fetuin-A and osteopontin (OPN) inhibit VC. Serum fetuin-A levels are lower in patients with end-stage kidney disease (ESKD) and in those who are on chronic HD therapy. However, there are limited data concerning OPN in patients who are on dialysis. The aim of our study was to determine VC in HD patients, the relationship between VC and 25-OH-vitamin D, fetuin-A, and OPN levels, and independent predictors of VC.
Ninety-three patients with ESKD on HD therapy were recruited. Among these patients, 44 were male and 49 were female. The patient group was compared with a group of 20 healthy controls of similar age and sex. A plain radiograph of the hand was taken using a mammography machine for the evaluation of VC. Serum fetuin-A, OPN, and 25-OH-vitamin D levels of both patients and controls were measured.
VC was detected in 45 (48.4%) HD patients. When patients were compared with healthy controls, fetuin-A levels (p < 0.029) were significantly lower in patients, whereas OPN (p < 0.000) and VC (p < 0.002) were significantly higher in the patient group. Age [odds ratio (OR) 1.036], the presence of diabetes mellitus (DM) (OR 17.527), and high parathyroid hormone (PTH) levels (OR 1.002) were independent predictors of VC in a logistic regression model including the following factors: age, the presence of DM, HD duration, and serum albumin, phosphate, PTH, 25-OH-vitamin D, fetuin-A, OPN, and calcium levels. No significant correlation was found between patients with VC and patients without VC in terms of fetuin-A, OPN, and 25-OH-vitamin D levels.
VC is a frequent sign in patients undergoing HD and is not related to serum fetuin-A and osteopontin levels. Age, the presence of DM, and high PTH levels were independent predictors of VC in patients undergoing HD. Further studies are warranted to understand the mechanism underlying and the factors contributing to VC.
血液透析（HD）患者的血管钙化（VC）是严重心血管疾病的标志，并可预测心血管结局。胎球蛋白-A 和骨桥蛋白（OPN）可抑制 VC。终末期肾病（ESKD）患者和接受慢性 HD 治疗的患者血清胎球蛋白-A 水平较低。然而，关于接受透析的患者的 OPN 数据有限。我们的研究目的是确定 HD 患者的 VC，VC 与 25-羟维生素 D、胎球蛋白-A 和 OPN 水平之间的关系，以及 VC 的独立预测因素。
招募了 93 名接受 HD 治疗的 ESKD 患者。其中 44 名男性，49 名女性。将患者组与年龄和性别相似的 20 名健康对照组进行比较。使用乳腺 X 光机对手部进行平片检查，以评估 VC。测量患者和对照组的血清胎球蛋白-A、OPN 和 25-羟维生素 D 水平。
在 45 名（48.4%）HD 患者中检测到 VC。与健康对照组相比，患者的胎球蛋白-A 水平明显降低（p<0.029），而 OPN（p<0.000）和 VC（p<0.002）水平明显升高。在包括年龄、糖尿病（DM）存在（OR 17.527）和高甲状旁腺激素（PTH）水平（OR 1.002）在内的逻辑回归模型中，年龄（OR 1.036）是 VC 的独立预测因素。包括年龄、DM 存在、HD 持续时间以及血清白蛋白、磷酸盐、PTH、25-羟维生素 D、胎球蛋白-A、OPN 和钙水平。VC 阳性患者与 VC 阴性患者之间的胎球蛋白-A、OPN 和 25-羟维生素 D 水平无显著相关性。
VC 是 HD 患者的常见表现，与血清胎球蛋白-A 和 OPN 水平无关。年龄、DM 存在和高 PTH 水平是 HD 患者 VC 的独立预测因素。需要进一步研究以了解 VC 发生的机制和相关因素。
