与终末期肾病的日本患者主动脉瓣狭窄相关的因素。

Factors associated with aortic valve stenosis in Japanese patients with end-stage kidney disease.

机构信息

Department of Internal Medicine, Fujita Health University Bantane Hospital, Aichi, Japan.

Department of Nephrology, Fujita Health University, Aichi, Japan.

出版信息

BMC Nephrol. 2022 Apr 2;23(1):129. doi: 10.1186/s12882-022-02758-y.

DOI:10.1186/s12882-022-02758-y

PMID:35366815

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8977035/

Abstract

BACKGROUND

Aortic valve stenosis (AS) has a high prevalence and poor prognosis in patients who receive maintenance dialysis. However, few large-scale observational studies in Japan have investigated patients with AS who underwent dialysis. In this study, we investigated the prevalence and factors associated with AS in Japanese patients who underwent dialysis.

METHODS

In this cross-sectional analysis, we enrolled patients who underwent dialysis and transthoracic echocardiography between July 1, 2017 and June 30, 2018. Patients with a maximum aortic jet velocity (Vmax) ≥ 2.0 m/s, pressure gradient (PG) between the left ventricle and ascending aorta (mean PG) ≥ 20 mmHg, or aortic valve area (AVA) ≤ 1.0 cm were categorized into the AS group (G1). Patients with Vmax ≥ 3.0 m/s, mean PG ≥ 20 mmHg, or AVA ≤ 1.0 cm were categorized into the moderate and severe AS groups (G2). We performed multivariate logistic regression analysis and compared G1 and G2 with the non-AS group to determine the risk factors for AS. We also investigated the risk factors for aortic valve calcification, which is a pre-stage for AS.

RESULTS

Of the 2,786 patients investigated, 555 (20.0%) and 193 (6.9%) were categorized into G1 and G2, respectively. Multivariate logistic regression analysis revealed that age, long-term dialysis, and elevated serum phosphorus levels were associated with AS in both the groups (p < 0.05). These factors were converted into ordinal categories, and a multivariate logistic regression analysis was performed. Patients with serum phosphorus levels measuring 5.0-5.9 mg/dL and > 6.0 mg/dL showed a higher risk of AS than those with serum phosphorus levels measuring < 4.0 mg/dL (odds ratio 2.24, p = 0.01 and odds ratio 2.66, p = 0.005, respectively). Aortic valve calcification was associated with age, long-term dialysis, diabetes mellitus, administration of vitamin D receptor activators, elevated serum calcium levels, and anemia (p < 0.05 for all).

CONCLUSIONS

Patients on dialysis showed a high prevalence of AS, which was associated with age, long-term dialysis, and elevated serum phosphorus levels.

TRIAL REGISTRATION

UMIN000026756 , registered on March 29, 2017.

摘要

背景

主动脉瓣狭窄（AS）在接受维持性透析的患者中患病率高，预后差。然而，在日本，很少有大规模的观察性研究调查接受透析的 AS 患者。本研究调查了日本透析患者中 AS 的患病率及相关因素。

方法

在这项横断面分析中，我们纳入了 2017 年 7 月 1 日至 2018 年 6 月 30 日期间接受透析和经胸超声心动图检查的患者。最大主动脉瓣射流速度（Vmax）≥2.0 m/s、左心室与升主动脉之间的压力梯度（平均 PG）≥20 mmHg 或主动脉瓣面积（AVA）≤1.0 cm 的患者归入 AS 组（G1）。Vmax≥3.0 m/s、平均 PG≥20 mmHg 或 AVA≤1.0 cm 的患者归入中重度 AS 组（G2）。我们进行了多变量逻辑回归分析，并将 G1 和 G2 与非 AS 组进行比较，以确定 AS 的危险因素。我们还研究了主动脉瓣钙化的危险因素，这是 AS 的前期阶段。

结果

在 2786 名接受调查的患者中，555 名（20.0%）和 193 名（6.9%）患者分别归入 G1 和 G2。多变量逻辑回归分析显示，两组中年龄、长期透析和血清磷水平升高与 AS 相关（p<0.05）。这些因素被转化为有序类别，并进行了多变量逻辑回归分析。血清磷水平为 5.0-5.9 mg/dL 和>6.0 mg/dL 的患者发生 AS 的风险高于血清磷水平<4.0 mg/dL 的患者（比值比 2.24，p=0.01 和比值比 2.66，p=0.005）。主动脉瓣钙化与年龄、长期透析、糖尿病、维生素 D 受体激动剂的使用、血清钙水平升高和贫血有关（p<0.05）。