Dai Lu, Plunde Oscar, Qureshi Abdul Rashid, Lindholm Bengt, Brismar Torkel B, Schurgers Leon J, Söderberg Magnus, Ripsweden Jonaz, Bäck Magnus, Stenvinkel Peter
Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86 Huddinge, Stockholm, Sweden.
Department of Medicine, Karolinska Institutet, 171 76 Solna, Stockholm, Sweden.
J Clin Med. 2020 Feb 24;9(2):607. doi: 10.3390/jcm9020607.
Aortic valve calcium (AVC) and coronary artery calcium (CAC) are common complications in end-stage renal disease (ESRD). We investigated the prognostic significance of overlapping presence of AVC and CAC, and whether AVC was associated with all-cause mortality independent of the presence of CAC in ESRD.
259 ESRD patients (median age 55 years, 67% males) undergoing cardiac computed tomography were included. Framingham risk score (FRS), presence of cardiovascular disease (CVD), statin use, nutritional status and other relevant laboratory data were determined at baseline. During follow-up for median 36 months, 44 patients died, and 68 patients underwent renal transplantation.
The baseline overlap presence of AVC and CAC was 37%. Multivariate regression analysis showed that FRS (odds ratio (OR) 2.25; 95% confidence interval (95% CI), 1.43-3.55) and CAC score (OR (95% CI), 2.18 (1.34-3.59)) were independent determinants of AVC. In competing-risk regression models adjusted for presence of CAC, inflammation, nutritional status, CVD, FRS and statin use, AVC remained independently associated with all-cause mortality (sub-hazard ratio (95% CI), 2.57 (1.20-5.51)).
The overlap of AVC and CAC was 37% in this ESRD cohort. AVC was associated with increased all-cause mortality independent of presence of CAC, traditional risk factors and inflammation.
主动脉瓣钙化（AVC）和冠状动脉钙化（CAC）是终末期肾病（ESRD）的常见并发症。我们研究了AVC和CAC重叠存在的预后意义，以及在ESRD中，AVC是否独立于CAC的存在与全因死亡率相关。
纳入259例接受心脏计算机断层扫描的ESRD患者（中位年龄55岁，67%为男性）。在基线时确定弗雷明汉风险评分（FRS）、心血管疾病（CVD）的存在、他汀类药物的使用、营养状况和其他相关实验室数据。在中位36个月的随访期间，44例患者死亡，68例患者接受了肾移植。
AVC和CAC在基线时的重叠存在率为37%。多变量回归分析显示，FRS（比值比（OR）2.25；95%置信区间（95%CI），1.43 - 3.55）和CAC评分（OR（95%CI），2.18（1.34 - 3.59））是AVC的独立决定因素。在针对CAC的存在、炎症、营养状况、CVD、FRS和他汀类药物使用进行调整的竞争风险回归模型中，AVC仍然独立于全因死亡率相关（亚风险比（95%CI），2.57（1.20 - 5.51））。
在这个ESRD队列中，AVC和CAC的重叠率为37%。AVC与全因死亡率增加相关，独立于CAC的存在、传统风险因素和炎症。
