Disthabanchong Sinee, Vipattawat Kotcharat, Phakdeekitcharoen Bunyong, Kitiyakara Chagriya, Sumethkul Vasant
Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, 7th floor, Building 1, Phayathai, Bangkok, 10400, Thailand.
Ramathibodi Organ Transplant Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Int Urol Nephrol. 2018 Feb;50(2):355-364. doi: 10.1007/s11255-017-1758-9. Epub 2017 Dec 13.
Vascular calcification is common in chronic kidney disease (CKD) and predicts poor patient outcomes. While computed tomography is the gold standard for evaluation of vascular calcification, plain radiograph offers a simpler and less costly alternative. The calcification of abdominal aorta, iliac and femoral arteries has been evaluated by plain radiograph, but the data on their outcome predictabilities are still limited. The present study investigated the role of abdominal aortic calcification (AAC) and pelvic arterial calcification (PAC) in predicting overall morality in non-dialysis CKD stages 2-5 (CKD 2-5), maintenance hemodialysis (HD) and long-term kidney transplant (KT) patients.
Four hundred and nineteen patients were included. Lateral abdominal and pelvic radiographs were obtained. The degree of AAC and PAC was evaluated according to the methods described previously by Kaupplia et al. and Adragao et al. Patients were followed prospectively for 5 years.
AAC and PAC scores correlated well with the correlation coefficients of 0.442 for CKD 2-5, 0.438 for HD and 0.586 for KT (p < 0.001). Patients with AAC score > 6 or PAC score > 1 were older, showed higher prevalence of DM and had higher serum phosphate and PTH but lower serum albumin and eGFR. A more severe degree of AAC was associated with an increase in KT duration, whereas a more severe degree of PAC was associated with worsening kidney function and prolonged dialysis vintage. Kaplan-Meier survival curves revealed AAC score > 6 as a significant predictor of all-cause mortality in CKD 2-5 but not in HD or KT, whereas PAC score > 1 was a significant predictor of all-cause mortality in all three populations. After adjusting for age, the predictability of AAC was lost, whereas PAC remained an independent predictor of mortality in all three populations. Adjustments for cardiovascular and CKD risk factors including age, gender, BMI, DM, serum albumin, calcium and phosphate attenuated the predictability of PAC in HD but not in CKD 2-5 or KT patients.
PAC was better than AAC in predicting mortality in CKD, HD and KT patients.
血管钙化在慢性肾脏病（CKD）中很常见，且预示着患者预后不良。虽然计算机断层扫描是评估血管钙化的金标准，但普通X线平片提供了一种更简单且成本更低的替代方法。腹主动脉、髂动脉和股动脉的钙化已通过普通X线平片进行评估，但其预后预测性的数据仍然有限。本研究调查了腹主动脉钙化（AAC）和盆腔动脉钙化（PAC）在预测非透析CKD 2 - 5期（CKD 2 - 5）、维持性血液透析（HD）和长期肾移植（KT）患者全因死亡率中的作用。
纳入419例患者。获取腹部和盆腔侧位X线平片。根据Kaupplia等人和Adragao等人先前描述的方法评估AAC和PAC的程度。对患者进行了为期5年的前瞻性随访。
AAC和PAC评分具有良好的相关性，CKD 2 - 5期的相关系数为0.442，HD为0.438，KT为0.586（p < 0.001）。AAC评分>6或PAC评分>1的患者年龄更大，糖尿病患病率更高，血清磷酸盐和甲状旁腺激素水平更高，但血清白蛋白和估算肾小球滤过率更低。更严重程度的AAC与KT持续时间增加相关，而更严重程度的PAC与肾功能恶化和透析时间延长相关。Kaplan - Meier生存曲线显示，AAC评分>6是CKD 2 - 5期全因死亡率的显著预测指标，但在HD或KT患者中并非如此，而PAC评分>1是所有这三组人群全因死亡率的显著预测指标。调整年龄后，AAC的预测性消失，而PAC在所有三组人群中仍然是死亡率的独立预测指标。对包括年龄、性别、体重指数、糖尿病、血清白蛋白、钙和磷酸盐在内的心血管和CKD危险因素进行调整后，减弱了PAC在HD患者中的预测性，但在CKD 2 - 5期或KT患者中并未减弱。
在预测CKD、HD和KT患者的死亡率方面，PAC优于AAC。
