Plytzanopoulou Petrini, Papasotiriou Marios, Politis Panagiotis, Papachrysanthou Theodora, Andriopoulos Christos, Drakou Athina, Papachristou Evangelos, Papastamatiou Miltiadis, Kehagias Ioannis
Department of Nutrition, "Konstantopouleio" General Hospital of Athens, Athens, Greece.
Department of Nephrology, University Hospital of Patras, Patras, Greece.
Clin Nutr ESPEN. 2022 Dec;52:421-430. doi: 10.1016/j.clnesp.2022.09.023. Epub 2022 Sep 26.
BACKGROUND & AIMS: Cardiac valve calcification (CVC) is a predictor of cardiovascular disease and all-cause mortality in end stage kidney disease (ESKD) patients. Several risk factors are related to CVC in patients with ESKD including traditional ones as well as inflammation, bone mineral disease and malnutrition. Adiposity is associated with dyslipidemia and proinflammatory activity which could predispose for CVC. Sarcopenia or dynapenia is a state common in patients with ESKD. This study aimed to investigate the relationship of adiposity, sarcopenia and malnutrition-inflammation markers with CVC in patients on maintenance hemodialysis.
CVC in aortic (AVC), mitral valves (MVC) and systolic and diastolic dysfunction (DD) were assessed by using two-dimensional echocardiography. Nutritional, adiposity and anthropometric assessments were made using several indices respectively. Creatinine index and muscle strength measurements were also performed. Biochemical parameters such as total proteins, albumin, calcium, phosphate, plasma lipoproteins, C-Reactive Protein and parathyroid hormone were also measured.
Adiposity, nutritional, and sarcopenia parameters did not show any difference between patients with or without CVC. Age ≥ 65 years [PR: 1.47 p = 0.012], DD [PR: 2.31, p = 0.005], high CRP/albumin ratio [PR: 1.46, p = 0.01], mid arm circumference (MAC) < 26 cm [PR: 1.37, p = 0.03] were associated with increased prevalence of AVC, while DD [PR: 1.97 p = 0.02], high CRP/albumin ratio [PR: 1.56, p = 0.02], and MAC < 26 cm [PR: 1.52, p = 0.01], showed positive correlation with MVC. Age ≥ 65 years [PR: 1.33, p = 0.028], DD [PR: 1.72, p = 0.01], high CRP/albumin ratio [PR: 1.53, p = 0.003], and MAC < 26 cm [PR: 1.4, p = 0.006], related to greater prevalence of calcification at any valve.
Ageing, diastolic dysfunction, MAC and increased CRP/albumin ratio were powerful predictors of CVC in patients on hemodialysis.
心脏瓣膜钙化（CVC）是终末期肾病（ESKD）患者心血管疾病和全因死亡率的预测指标。ESKD患者的CVC与多种危险因素相关，包括传统危险因素以及炎症、骨矿物质疾病和营养不良。肥胖与血脂异常和促炎活性有关，这可能易导致CVC。肌肉减少症或肌无力在ESKD患者中很常见。本研究旨在探讨维持性血液透析患者中肥胖、肌肉减少症和营养不良炎症标志物与CVC的关系。
采用二维超声心动图评估主动脉瓣钙化（AVC）、二尖瓣钙化（MVC）以及收缩和舒张功能障碍（DD）情况。分别使用多个指标进行营养、肥胖和人体测量评估。还进行了肌酐指数和肌肉力量测量。同时测量总蛋白、白蛋白、钙、磷、血浆脂蛋白、C反应蛋白和甲状旁腺激素等生化参数。
肥胖、营养和肌肉减少症参数在有或无CVC的患者之间未显示出任何差异。年龄≥65岁[风险比（PR）：1.47，p = 0.012]、DD[PR：2.31，p = 0.005]、高CRP/白蛋白比值[PR：1.46，p = 0.01]、上臂中段周长（MAC）<26 cm[PR：1.37，p = 0.03]与AVC患病率增加相关，而DD[PR：1.97，p = 0.02]、高CRP/白蛋白比值[PR：1.56，p = 0.02]和MAC<26 cm[PR：1.52，p = 0.01]与MVC呈正相关。年龄≥65岁[PR：1.33，p = 0.028]、DD[PR：1.72，p = 0.01]、高CRP/白蛋白比值[PR：1.53，p = 0.003]和MAC<26 cm[PR：1.4，p = 0.006]与任何瓣膜钙化的患病率较高有关。
衰老、舒张功能障碍、MAC和CRP/白蛋白比值升高是血液透析患者CVC的有力预测指标。
