Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Dianet Dialysis Centers, Utrecht, The Netherlands.
PLoS One. 2020 Dec 30;15(12):e0244639. doi: 10.1371/journal.pone.0244639. eCollection 2020.
Cardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) and is strongly associated with vascular calcification. An important driver of vascular calcification is high phosphate levels, but these become lower when patients initiate nocturnal hemodialysis or receive a kidney transplant. However, it is unknown whether nocturnal hemodialysis or kidney transplantation mitigate vascular calcification. Therefore, we compared progression of coronary artery calcification (CAC) between patients treated with conventional hemodialysis, nocturnal hemodialysis, and kidney transplant recipients.
We measured CAC annually up to 3 years in 114 patients with ESRD that were transplantation candidates: 32 that continued conventional hemodialysis, 34 that initiated nocturnal hemodialysis (≥4x 8 hours/week), and 48 that received a kidney transplant. We compared CAC progression between groups as the difference in square root transformed volume scores per year (ΔCAC SQRV) using linear mixed models. Reference category was conventional hemodialysis.
The mean age of the study population was 53 ±13 years, 75 (66%) were male, and median dialysis duration was 28 (IQR 12-56) months. Median CAC score at enrollment was 171 (IQR 10-647), which did not differ significantly between treatment groups (P = 0.83). Compared to conventional hemodialysis, CAC progression was non-significantly different in nocturnal hemodialysis -0.10 (95% CI -0.77 to 0.57) and kidney transplantation -0.33 (95% CI -0.96 to 0.29) in adjusted models.
Nocturnal hemodialysis and kidney transplantation are not associated with significantly less CAC progression compared to conventional hemodialysis during up to 3 years follow-up. Further studies are needed to confirm these findings, to determine which type of calcification is measured with CAC in end-stage renal disease, and whether that reflects cardiovascular risk.
心血管疾病是终末期肾病（ESRD）患者死亡的主要原因，与血管钙化密切相关。血管钙化的一个重要驱动因素是高磷水平，但当患者开始夜间血液透析或接受肾移植时，这些水平会降低。然而，目前尚不清楚夜间血液透析或肾移植是否能减轻血管钙化。因此，我们比较了接受常规血液透析、夜间血液透析和肾移植患者的冠状动脉钙化（CAC）进展情况。
我们在 114 名接受 ESRD 治疗的移植候选患者中每年测量一次 CAC，随访时间长达 3 年：32 名继续接受常规血液透析，34 名开始夜间血液透析（每周≥4x8 小时），48 名接受肾移植。我们使用线性混合模型比较了各组间每年 CAC 进展的差异（以每平方根变换体积分数的差异（ΔCAC SQRV）表示）。参考类别为常规血液透析。
研究人群的平均年龄为 53±13 岁，75 人（66%）为男性，透析时间中位数为 28（IQR 12-56）个月。入组时 CAC 评分中位数为 171（IQR 10-647），各组间无显著差异（P=0.83）。与常规血液透析相比，夜间血液透析组的 CAC 进展差异无统计学意义（-0.10，95%CI-0.77 至 0.57），肾移植组差异也无统计学意义（-0.33，95%CI-0.96 至 0.29），调整后的模型。
与常规血液透析相比，在长达 3 年的随访期间，夜间血液透析和肾移植与 CAC 进展的相关性无明显差异。需要进一步的研究来证实这些发现，以确定在终末期肾病中 CAC 测量的是哪种类型的钙化，以及该钙化是否反映心血管风险。
