School of Medicine, University of Belgrade, Belgrade, Serbia.
Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, Belgrade, 11000, Serbia.
Int Urol Nephrol. 2018 May;50(5):939-946. doi: 10.1007/s11255-018-1821-1. Epub 2018 Feb 13.
Cardiovascular calcifications (CVC) are present in up to 70% of non-diabetic dialysis patients. Sparse data are available on predictors of very long-term outcomes of such patients. The Belgrade Aachen Study on Calcification in Hemodialysis patients (BASCH study) aimed to study this using a comprehensive CVC assessment.
We prospectively analyzed 220 hemodialysis patients followed for a mean of 76 months (median 73 months, range 6-160 months). We compared patients deceased from cardiovascular diseases (CVD) and survivors. Analyses included composite calcification scores (determined by combining ultrasound and X-ray analyses), demographic, clinical and laboratory data and pulse wave velocity (PWV). For survival analysis, patients were divided into group according to quartiles (Q).
Compared to survivors, deceased patients from CVD were significantly older, more frequently hypertensive, had shorter dialysis times per week and lower Kt/V values, and they exhibited lower serum fetuin A, osteoprotegerin and hemoglobin as well as higher CRP levels. Composite calcification and Adragao scores were significantly higher in deceased patients from CVD as was PWV. Mean survival was 101 ± 47 months (Q1), 87 ± 51 month (Q2), 66 ± 48 (Q3) and 54 ± 45 months (Q4), p = 0.000. Cox multivariate regression analysis showed that independent predictors for cardiovascular mortality were composite calcification score in the range of third and fourth quartiles.
Composite calcification score emerged as significant predictors of long-term survival in our group of largely non-diabetic dialysis patient population, finding that should be confirmed by intervention studies.
心血管钙化（CVC）存在于高达 70%的非糖尿病透析患者中。关于此类患者的极长期预后的预测因素的数据很少。贝尔格莱德-亚琛血液透析患者钙化研究（BASCH 研究）旨在使用综合 CVC 评估来研究这一点。
我们前瞻性分析了 220 名接受平均 76 个月（中位数 73 个月，范围 6-160 个月）随访的血液透析患者。我们比较了死于心血管疾病（CVD）的患者和幸存者。分析包括综合钙化评分（通过结合超声和 X 射线分析确定）、人口统计学、临床和实验室数据以及脉搏波速度（PWV）。为了进行生存分析，根据四分位数（Q）将患者分为组。
与幸存者相比，死于 CVD 的患者年龄更大、更常患有高血压、每周透析时间更短、Kt/V 值更低，血清胎球蛋白 A、骨保护素和血红蛋白水平更低，C 反应蛋白水平更高。死于 CVD 的患者的综合钙化和 Adragao 评分以及 PWV 明显更高。平均生存时间为 101±47 个月（Q1）、87±51 个月（Q2）、66±48 个月（Q3）和 54±45 个月（Q4），p=0.000。Cox 多变量回归分析显示，第三和第四四分位复合钙化评分是心血管死亡率的独立预测因素。
综合钙化评分是我们的非糖尿病透析患者群体的长期生存的重要预测因素，这一发现应通过干预研究得到证实。
