Department of Nephrology, Peking University People's Hospital, Beijing, China.
Department of Nephrology, Peking University People's Hospital, Beijing, China,
Blood Purif. 2019;47 Suppl 1(Suppl 1):8-16. doi: 10.1159/000496218. Epub 2019 Jan 30.
To investigate the occurrence of vascular calcification (VC) in different types of arteries in patients with maintenance peritoneal dialysis (PD) patients and its influencing factors.
This study enrolled PD patients with stable status who has received PD treatment for more than 6 months in Peking University People's Hospital. We used plain X-ray films of abdomen, pelvis, and hands to quantitatively evaluate VC of large artery (abdominal aorta, iliac artery), medium artery (femoral artery, radial artery), and small artery (finger arteries). Two radiologists read and scored radiographs blindly. Demographic data, clinical characteristics, Charlson comorbidity index (CCI), baseline and time-average laboratory indices including parameters of calcium phosphorus metabolism, serum albumin, PD adequacy were collected. A logistic regression model was used to estimate the influencing factors of different sites of VC.
(1) 154 PD patients were enrolled in this study: seventy-eight males, mean age was 60.4 ± 13.9 years, and median PD duration was 24 (16.39) months. The major primary disease was diabetic nephropathy (39%). (2) Among the 154 PD patients, the proportion of calcification of large artery was the highest (found in 100 patients, accounting for 64.9%); then the medium artery (66, 42.9%); and 15 of small artery, accounting for 9.7%. (3) Logistic regression showed that older age, longer dialysis duration, lower baseline serum intact parathyroid hormone (iPTH), and higher CCI scores were independent risk factors of large artery calcification (p < 0.05), and higher CCI scores, higher baseline serum triglycerides (TG), lower baseline serum iPTH, and time-average iPTH were independent risk factors of medium and small arteries.
In PD patients, the occurrence of large artery calcification was higher than others. Among different sites of VC, the abdominal aortic calcification was most likely to occur, and the proportion of small artery calcification was low. Calcification of medium and small arteries can exist alone without calcification of large artery. Large artery calcification was more likely to occur in patients with older age, longer dialysis duration, lower baseline serum iPTH levels and higher CCI scores. Patients with higher CCI scores, higher baseline TG and lower baseline iPTH, and time-average iPTH were more likely to develop small and medium artery calcification.
探讨维持性腹膜透析（PD）患者不同类型动脉血管钙化（VC）的发生情况及其影响因素。
本研究纳入北京大学人民医院稳定期 PD 患者，PD 治疗时间超过 6 个月。采用腹部、骨盆和手部的普通 X 射线片对大动脉（腹主动脉、髂动脉）、中动脉（股动脉、桡动脉）和小动脉（指动脉）的 VC 进行定量评估。两位放射科医生对 X 射线片进行盲法阅读和评分。收集人口统计学数据、临床特征、Charlson 合并症指数（CCI）、基线和时间平均实验室指标，包括钙磷代谢、血清白蛋白、PD 充分性的参数。采用 logistic 回归模型估计不同部位 VC 的影响因素。
（1）本研究共纳入 154 例 PD 患者：78 例男性，平均年龄 60.4±13.9 岁，中位 PD 时间为 24（16.39）个月。主要原发病为糖尿病肾病（39%）。（2）154 例 PD 患者中，大血管钙化比例最高（100 例，占 64.9%）；其次为中动脉（66 例，占 42.9%）；小动脉 15 例，占 9.7%。（3）logistic 回归显示，年龄较大、透析时间较长、基线血清全段甲状旁腺激素（iPTH）较低、CCI 评分较高是大血管钙化的独立危险因素（p<0.05），CCI 评分较高、基线血清甘油三酯（TG）较高、基线血清 iPTH 较低、时间平均 iPTH 是中、小动脉的独立危险因素。
在 PD 患者中，大血管钙化的发生率高于其他血管。在不同部位的 VC 中，腹主动脉钙化最常见，小动脉钙化的比例较低。中、小动脉钙化可单独存在而无大血管钙化。年龄较大、透析时间较长、基线血清 iPTH 水平较低、CCI 评分较高的患者更容易发生大血管钙化。CCI 评分较高、基线 TG 较高、基线 iPTH 较低、时间平均 iPTH 的患者更容易发生中、小动脉钙化。
