Prognostic value of cardiovascular calcifications in hemodialysis patients: a longitudinal study

被引:10
作者
Dimkovic, Nada [1 ,2 ]
Schlieper, Georg [3 ]
Jankovic, Aleksandar [2 ]
Djuric, Zivka [2 ]
Ketteler, Marcus [4 ]
Damjanovic, Tatjana [2 ]
Djuric, Petar [2 ]
Marinkovic, Jelena [5 ]
Radojcic, Zoran [6 ]
Markovic, Natasa [2 ]
Floege, Juergen [3 ]
机构
[1] Univ Belgrade, Sch Med, Belgrade, Serbia
[2] Zvezdara Univ, Clin Dept Renal Dis, Med Ctr, Dimitrija Tucov 161, Belgrade 11000, Serbia
[3] Rhein Westfal TH Aachen, Dept Nephrol & Clin Immunol, Aachen, Germany
[4] Klinikum Coburg GmbH, Coburg, Germany
[5] Univ Belgrade, Inst Med Stat & Informat, Sch Med, Belgrade, Serbia
[6] Univ Belgrade, Fac Org Sci, Stat Lab, Belgrade, Serbia
关键词
Cardiovascular calcifications; Hemodialysis; Calcification inhibitors; Calcification promoters; Long-term survival; CHRONIC KIDNEY-DISEASE; MATRIX GLA PROTEIN; CORONARY-ARTERY CALCIFICATION; STAGE RENAL-DISEASE; VASCULAR CALCIFICATION; FETUIN-A; MAINTENANCE HEMODIALYSIS; RISK-FACTORS; MORTALITY; ASSOCIATION;
D O I
10.1007/s11255-018-1821-1
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Cardiovascular calcifications (CVC) are present in up to 70% of non-diabetic dialysis patients. Sparse data are available on predictors of very long-term outcomes of such patients. The Belgrade Aachen Study on Calcification in Hemodialysis patients (BASCH study) aimed to study this using a comprehensive CVC assessment. We prospectively analyzed 220 hemodialysis patients followed for a mean of 76 months (median 73 months, range 6-160 months). We compared patients deceased from cardiovascular diseases (CVD) and survivors. Analyses included composite calcification scores (determined by combining ultrasound and X-ray analyses), demographic, clinical and laboratory data and pulse wave velocity (PWV). For survival analysis, patients were divided into group according to quartiles (Q). Compared to survivors, deceased patients from CVD were significantly older, more frequently hypertensive, had shorter dialysis times per week and lower Kt/V values, and they exhibited lower serum fetuin A, osteoprotegerin and hemoglobin as well as higher CRP levels. Composite calcification and Adragao scores were significantly higher in deceased patients from CVD as was PWV. Mean survival was 101 +/- 47 months (Q1), 87 +/- 51 month (Q2), 66 +/- 48 (Q3) and 54 +/- 45 months (Q4), p = 0.000. Cox multivariate regression analysis showed that independent predictors for cardiovascular mortality were composite calcification score in the range of third and fourth quartiles. Composite calcification score emerged as significant predictors of long-term survival in our group of largely non-diabetic dialysis patient population, finding that should be confirmed by intervention studies.
引用
收藏
页码:939 / 946
页数:8
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