Department of Endocrinology, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China.
Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
Cardiovasc Diabetol. 2024 Jul 18;23(1):259. doi: 10.1186/s12933-024-02318-8.
The main goal of this study was to examine how diabetes, cardiovascular calcification characteristics and other risk factors affect mortality in end-stage renal disease (ESRD) patients in the early stages of hemodialysis.
A total of 285 ESRD patients in the early stages of hemodialysis were enrolled in this research, including 101 patients with diabetes. Survival time was monitored, and general data, biochemical results, cardiac ultrasound calcification of valvular tissue, and thoracic CT calcification of the coronary artery and thoracic aorta were recorded. Subgroup analysis and logistic regression were applied to investigate the association between diabetes and calcification. Cox regression analysis and survival between calcification, diabetes, and all-cause mortality. Additionally, the nomogram model was used to estimate the probability of survival for these individuals, and its performance was evaluated using risk stratification, receiver operating characteristic, decision, and calibration curves.
Cardiovascular calcification was found in 81.2% of diabetic patients (82/101) and 33.7% of nondiabetic patients (62/184). Diabetic patients had lower phosphorus, calcium, calcium-phosphorus product, plasma PTH levels and lower albumin levels (p < 0.001). People with diabetes were more likely to have calcification than people without diabetes (OR 5.66, 95% CI 1.96-16.36; p < 0.001). The overall mortality rate was 14.7% (42/285). The risk of death was notably greater in patients with both diabetes and calcification (29.27%, 24/82). Diabetes and calcification, along with other factors, collectively predict the risk of death in these patients. The nomogram model demonstrated excellent discriminatory power (area under the curve (AUC) = 0.975 at 5 years), outstanding calibration at low to high-risk levels and provided the greatest net benefit across a wide range of clinical decision thresholds.
In patients with ESRD during the early period of haemodialysis, diabetes significantly increases the risk of cardiovascular calcification, particularly multisite calcification, which is correlated with a higher mortality rate. The risk scores and nomograms developed in this study can assist clinicians in predicting the risk of death and providing individualised treatment plans to lower mortality rates in the early stages of hemodialysis.
本研究的主要目的是探讨糖尿病、心血管钙化特征和其他危险因素对接受血液透析早期的终末期肾病（ESRD）患者死亡率的影响。
共纳入 285 例血液透析早期的 ESRD 患者，其中糖尿病患者 101 例。监测生存时间，记录一般资料、生化结果、心脏瓣膜组织超声钙化、胸主动脉和冠状动脉 CT 钙化情况。采用亚组分析和逻辑回归探讨糖尿病与钙化的关系。采用 Cox 回归分析和生存分析探讨钙化、糖尿病与全因死亡率的关系。此外，采用列线图模型估计这些患者的生存概率，并通过风险分层、接受者操作特征、决策和校准曲线评估其性能。
101 例糖尿病患者中有 81.2%（82/101）存在心血管钙化，184 例非糖尿病患者中有 33.7%（62/184）存在心血管钙化。糖尿病患者的磷、钙、钙磷乘积、血浆甲状旁腺激素水平较低，白蛋白水平较低（p < 0.001）。糖尿病患者发生钙化的风险高于非糖尿病患者（OR 5.66，95%CI 1.96-16.36；p < 0.001）。总的死亡率为 14.7%（42/285）。糖尿病合并钙化患者的死亡风险显著更高（29.27%，24/82）。糖尿病和钙化以及其他因素共同预测了这些患者的死亡风险。列线图模型具有良好的区分能力（5 年时曲线下面积（AUC）为 0.975），在低风险到高风险水平均具有良好的校准度，并在广泛的临床决策阈值下提供了最大的净获益。
在接受血液透析早期的 ESRD 患者中，糖尿病显著增加心血管钙化的风险，尤其是多部位钙化，与更高的死亡率相关。本研究中建立的风险评分和列线图可以帮助临床医生预测死亡风险，并制定个体化治疗方案，以降低血液透析早期的死亡率。
