Guan Jichao, Xie Haiying, Wang Hongya, Gong Shuwen, Wu Xiujuan, Gong Tujian, Shen Shuijuan
Department of Nephrology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
Int Urol Nephrol. 2023 May;55(5):1271-1278. doi: 10.1007/s11255-022-03430-y. Epub 2022 Dec 1.
Cardiovascular events (CVE) are the leading cause of death in peritoneal dialysis (PD) patients. The predictive value of cardiac valve calcification (CVC) for CVE in dialysis patients remains controversial. In particular, such studies are limited in PD patients. We aimed to examine the predictive role of CVC for CVE and cardiovascular mortality in PD patients.
A retrospective analysis was performed on patients who initiated PD in our hospital. According to the result of echocardiography, patients were divided into CVC group and non-CVC group. The differences in baseline demographic characteristics, biochemical variables, comorbidities, and clinical outcomes between the two groups were compared. Kaplan-Meier method was used to obtain survival curves. The Cox regression model was used to evaluate the influence of CVC for cardiovascular outcomes. The inverse probability of treatment weighting (IPTW) was used to eliminate influence of the confounders in the groups.
458 peritoneal dialysis patients were enrolled in this study. 77 patients were in CVC group and 381 patients in non-CVC group. The average follow-up time was (32 ± 21) months. At baseline, the absolute standardized difference (ASD) of age, BMI, history of CVE, diabetes, LVEF, LVMI, albumin, calcium, phosphorus, triglycerides, hsCRP, urine volume, Kt/V, statins and vitamin D intake rate were greater than 0.1 between the two groups. All of ASD dropped to less than 0.1 after IPTW, which meant that the balance had been reached between the two groups. Multivariable logistic analysis showed that advanced age, diabetes, and hyperphosphatemia were associated with CVC. The Kaplan-Meier survival curve showed the cumulative CVE-free survival rate and cardiovascular survival rate of CVC group were significantly lower than that of non-CVC group before and after IPTW (log-rank P < 0.05). After IPTW was used to eliminate the effect of confounders, multivariate Cox regression analysis still showed CVC was an independent risk factor for CVE (HR = 2.383, 95% CI 1.3314.264, P = 0.003) and cardiovascular mortality (HR = 2.347, 95% CI 1.2114.548, P = 0.012) in PD patients.
The prevalence of CVC is high in peritoneal dialysis patients. CVC is an independent risk factor for CVE and cardiovascular mortality in peritoneal dialysis patients.
心血管事件（CVE）是腹膜透析（PD）患者的主要死亡原因。心脏瓣膜钙化（CVC）对透析患者CVE的预测价值仍存在争议。特别是，此类研究在PD患者中有限。我们旨在研究CVC对PD患者CVE和心血管死亡率的预测作用。
对我院开始进行PD的患者进行回顾性分析。根据超声心动图结果，将患者分为CVC组和非CVC组。比较两组患者基线人口统计学特征、生化变量、合并症和临床结局的差异。采用Kaplan-Meier法获得生存曲线。采用Cox回归模型评估CVC对心血管结局的影响。采用治疗权重逆概率（IPTW）消除组间混杂因素的影响。
本研究纳入458例腹膜透析患者。CVC组77例，非CVC组381例。平均随访时间为（32±21）个月。基线时，两组间年龄、BMI、CVE病史、糖尿病、左室射血分数（LVEF）、左室质量指数（LVMI）、白蛋白、钙、磷、甘油三酯、超敏C反应蛋白（hsCRP）、尿量、Kt/V、他汀类药物和维生素D摄入率的绝对标准化差异（ASD）大于0.1。IPTW后所有ASD均降至小于0.1，这意味着两组间已达到平衡。多变量逻辑分析显示，高龄、糖尿病和高磷血症与CVC相关。Kaplan-Meier生存曲线显示，IPTW前后CVC组的累积无CVE生存率和心血管生存率均显著低于非CVC组（对数秩检验P<0.05）。在使用IPTW消除混杂因素的影响后，多变量Cox回归分析仍显示CVC是PD患者CVE（HR=2.383，95%CI 1.3314.264，P=0.003）和心血管死亡率（HR=2.347，95%CI 1.2114.548，P=0.012）的独立危险因素。
腹膜透析患者CVC患病率较高。CVC是腹膜透析患者CVE和心血管死亡率的独立危险因素。
