Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Divisão de Nefrologia, Rio de Janeiro, RJ, Brasil.
J Bras Nefrol. 2021 Oct-Dec;43(4):478-485. doi: 10.1590/2175-8239-JBN-2020-0218.
Vascular calcification related to severe secondary hyperparathyroidism (SHPT) is an important cause of cardiovascular and bone complications, leading to high morbidity and mortality in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). The present study aimed to analyze whether ankle-brachial index (ABI), a non-invasive diagnostic tool, is able to predict cardiovascular outcomes in this population.
We selected 88 adult patients on HD for at least 6 months, with serum iPTH>1,000pg/mL. We collected clinical data, biochemical and hormonal parameters, and ABI (sonar-Doppler). Calcification was assessed by lateral radiography of the abdomen and by simple vascular calcification score (SVCS). This cohort was monitored prospectively between 2012 and 2019 for cardiovascular outcomes (death, myocardial infarction (MI), stroke, and calciphylaxis) to estimate the accuracy of ABI in this setting.
The baseline values were: iPTH: 1770±689pg/mL, P: 5.8±1.2 mg/dL, corrected Ca: 9.7±0.8mg/dL, 25(OH)vit D: 25.1±10.9ng/mL. Sixty-five percent of patients had ABI>1.3 (ranging from 0.6 to 3.2); 66% had SVCS≥3, and 45% aortic calcification (Kauppila≥8). The prospective evaluation (51.6±24.0 months), provided the following cardiovascular outcomes: 11% of deaths, 17% of nonfatal MI, one stroke, and 3% of calciphylaxis. After adjustments, patients with ABI≥1.6 had 8.9-fold higher risk of cardiovascular events (p=0.035), and ABI≥1.8 had 12.2-fold higher risk of cardiovascular mortality (p=0.019).
The presence of vascular calcifications and arterial stiffness was highly prevalent in our population. We suggest that ABI, a simple and cost-effective diagnostic tool, could be used at an outpatient basis to predict cardiovascular events in patients with severe SHPT undergoing HD.
与严重继发性甲状旁腺功能亢进症（SHPT）相关的血管钙化是心血管和骨并发症的重要原因，导致接受血液透析（HD）的慢性肾脏病（CKD）患者的发病率和死亡率居高不下。本研究旨在分析踝臂指数（ABI）这一非侵入性诊断工具是否能够预测该人群的心血管结局。
我们选择了 88 名至少接受了 6 个月 HD 治疗且血清 iPTH>1000pg/mL 的成年 HD 患者。我们收集了临床数据、生化和激素参数以及 ABI（超声多普勒）。通过腹部侧位放射摄影和简单的血管钙化评分（SVCS）评估钙化情况。该队列在 2012 年至 2019 年期间进行了前瞻性监测，以评估心血管结局（死亡、心肌梗死（MI）、中风和钙化防御），以评估 ABI 在该环境中的准确性。
基线值为：iPTH：1770±689pg/mL，P：5.8±1.2mg/dL，校正钙：9.7±0.8mg/dL，25（OH）维生素 D：25.1±10.9ng/mL。65%的患者 ABI>1.3（范围为 0.6 至 3.2）；66%的患者 SVCS≥3，45%的患者主动脉钙化（Kauppila≥8）。前瞻性评估（51.6±24.0 个月）提供了以下心血管结局：11%的死亡，17%的非致命性 MI，1 次中风和 3%的钙化防御。调整后，ABI≥1.6 的患者心血管事件的风险增加了 8.9 倍（p=0.035），ABI≥1.8 的患者心血管死亡率的风险增加了 12.2 倍（p=0.019）。
我们人群中血管钙化和动脉僵硬的发生率很高。我们建议，ABI 作为一种简单且具有成本效益的诊断工具，可在门诊基础上用于预测接受 HD 的严重 SHPT 患者的心血管事件。
