Department of Nutrition, "Konstantopouleio" General Hospital of Athens, Athens, Greece.
Department of Nephrology and Renal Transplantation, University Hospital of Patras, Patras, Greece.
Int Urol Nephrol. 2020 Nov;52(11):2205-2212. doi: 10.1007/s11255-020-02590-z. Epub 2020 Sep 22.
Cardiac valve calcification (CVC) is a significant risk factor for cardiovascular morbidity and mortality in patients with chronic kidney disease on maintenance hemodialysis. The aim of this study was to investigate the association of several risk factors and particularly of malnutrition on CVC.
In this cross-sectional cohort study, we included stable adult patients on maintenance hemodialysis. Calcification of cardiac valves was evaluated using two-dimensional echocardiography. Nutritional assessment and body composition measurements were performed using the MQSGA clinical tool and bioelectrical impedance analysis, respectively. Biochemical parameters such as serum calcium, phosphorus, iPTH, 1.25 hydroxy-vitamin-D, triglycerides, total cholesterol, HDL-C, LDL-C, total proteins, albumin, creatinine and CRP were assessed as potentially risk factors. The receiver operating characteristic (ROC) curve analysis was used to evaluate the prognostic ability of the aforementioned variables on severe degree CVC. Binary logistic regression analysis was also performed to identify independent variables of severe CVC.
Overall, 42 patients were included in the study with half of them exhibiting mitral calcification, 38% aortic valve calcification, and 16.7% calcification in both valves. ROC analysis indicated that aging (p = 0.011), increased CRP (p = 0.038) and decreased value of serum albumin to total proteins ratio (p = 0.012) were positive prognostic factors for moderate to severe degree cardiac valve calcification. Low phase angle was also associated with CVC, although with moderate specificity.
Aging, inflammation, low serum albumin to total proteins ratio and low phase angle values as indicators of malnutrition are predictors of severe CVC in end-stage renal disease patients on hemodialysis.
心脏瓣膜钙化（CVC）是慢性肾脏病维持性血液透析患者心血管发病率和死亡率的重要危险因素。本研究旨在探讨多种危险因素，特别是营养不良与 CVC 的关系。
本横断面队列研究纳入了稳定的成年维持性血液透析患者。使用二维超声心动图评估心脏瓣膜钙化。使用 MQSGA 临床工具和生物电阻抗分析分别进行营养评估和身体成分测量。评估血清钙、磷、iPTH、1.25 羟基维生素 D、甘油三酯、总胆固醇、HDL-C、LDL-C、总蛋白、白蛋白、肌酐和 CRP 等生化参数作为潜在危险因素。使用受试者工作特征（ROC）曲线分析评估上述变量对严重 CVC 的预后能力。还进行了二元逻辑回归分析，以确定严重 CVC 的独立变量。
共有 42 名患者纳入本研究，其中一半患者存在二尖瓣钙化，38%存在主动脉瓣钙化，16.7%存在双瓣膜钙化。ROC 分析表明，年龄（p=0.011）、CRP 升高（p=0.038）和血清白蛋白与总蛋白比值降低（p=0.012）是中重度心脏瓣膜钙化的阳性预后因素。低相位角也与 CVC 相关，但特异性中等。
在接受血液透析的终末期肾病患者中，年龄增长、炎症、低血清白蛋白与总蛋白比值和低相位角值等营养不良指标是严重 CVC 的预测因素。
