Study on the Prevalence of Vascular Calcification in Different Types of Arteries and Influencing Factors in Maintenance Peritoneal Dialysis Patients

Abstract

Objective: To investigate the occurrence of vascular calcification (VC) in different types of arteries in patients with maintenance peritoneal dialysis (PD) patients and its influencing factors. Methods: This study enrolled PD patients with stable status who has received PD treatment for more than 6 months in Peking University People’s Hospital. We used plain X-ray films of abdomen, pelvis, and hands to quantitatively evaluate VC of large artery (abdominal aorta, iliac artery), medium artery (femoral artery, radial artery), and small artery (finger arteries). Two radiologists read and scored radiographs blindly. Demographic data, clinical characteristics, Charlson comorbidity index (CCI), baseline and time-average laboratory indices including parameters of calcium phosphorus metabolism, serum albumin, PD adequacy were collected. A logistic regression model was used to estimate the influencing factors of different sites of VC. Results: (1) 154 PD patients were enrolled in this study: seventy-eight males, mean age was 60.4 ± 13.9 years, and median PD duration was 24 (16.39) months. The major primary disease was diabetic nephropathy (39%). (2) Among the 154 PD patients, the proportion of calcification of large artery was the highest (found in 100 patients, accounting for 64.9%); then the medium artery (66, 42.9%); and 15 of small artery, accounting for 9.7%. (3) Logistic regression showed that older age, longer dialysis duration, lower baseline serum intact parathyroid hormone (iPTH), and higher CCI scores were independent risk factors of large artery calcification (p < 0.05), and higher CCI scores, higher baseline serum triglycerides (TG), lower baseline serum iPTH, and time-average iPTH were independent risk factors of medium and small arteries. Conclusions: In PD patients, the occurrence of large artery calcification was higher than others. Among different sites of VC, the abdominal aortic calcification was most likely to occur, and the proportion of small artery calcification was low. Calcification of medium and small arteries can exist alone without calcification of large artery. Large artery calcification was more likely to occur in patients with older age, longer dialysis duration, lower baseline serum iPTH levels and higher CCI scores. Patients with higher CCI scores, higher baseline TG and lower baseline iPTH, and time-average iPTH were more likely to develop small and medium artery calcification.

Different type and dosage of heparin were not associated with the progression of coronary artery calcification in haemodialysis patients

“…Many underlying risk factors could promote transform of vascular smooth muscle cells to chondrocyte‐like or osteoblast‐like cells. These factors include P, Ca, iPTH, inflammatory cytokines, oxidative stress and advanced glycation end products . In Yang's study, they found that bovine aortic smooth muscle cells cultures can undergo a phenotypic transition into mature osteoblasts when cultured in the presence of beta‐glycerophosphate.…”

Взаимосвязь Сосудистой Кальцификации И Концентрации Остеопонтина В Плазме Крови У Пациентов На Заместительной Почечной Терапии Методом Перитонеального Диализа

“…[6], ðàñïðîñòðàí¸ííîñòü êàëüöèôèêàöèè êîðîíàðíûõ àðòåðèé ïàöèåíòîâ ñ ÕÁÏ â äîäèàëèçíûé ïåðèîä ñîñòàâèëà 40 % ïî ñðàâíåíèþ ñ 5-13 % â îáùåé ïîïóëÿöèè, [8]. Äëèòåëüíîñòü äèàëèçíîãî ëå÷åíèÿ ïî íàøèì ñâåäåíèÿì îêàçàëàñü çíà÷èìûì ôàêòîðîì, ñâÿçàííûì ñ âûðàaeåííîñòüþ ÊÁÀ (ð0,001) è îáóñëîâëåíî, î÷åâèäíî, äëèòåëüíîé ýêñïîçèöèåé ôàêòîðîâ ðèñêà ñåðäå÷íî-ñîñóäèñòîé ïàòîëîãèè ó äàííîé êàòåãîðèè ïàöèåíòîâ, ÷òî ïîäòâåðaeäàþò äàííûå ðÿäà èññëåäîâàíèé [9][10]. Ïðîâåä¸ííûé ìåaeãðóïïîâîé àíàëèç â îáñëåäîâàííîé ãðóïïå ïîêàçàë, ÷òî ïðè íàðàñòàíèè âûðàaeåííîñòè ÊÁÀ ó ïàöèåíòîâ áûëè áîëåå âûðàaeåíû íàðóøåíèÿ ôîñôîðíî-êàëüöèåâîãî îáìåíà (âûñîêèé óðîâåíü Ð è ïðîèçâåäåíèå Ñà  Ð), ÿâëåíèÿ ãèïåðïàðàòèðåîçà.…”

The effects of dialysis modalities on the progression of coronary artery calcification in dialysis patients

“…Meanwhile, inadequate dialyzer membrane biocompatibility aggravates inflammation and oxidative stress when the artificial materials contact with blood [11]. Oxidative stress and inflammation are also important factors that contribute to vascular calcification [12,13]. Inversely, PD has little influence on hemodynamics and better preservation of residual renal function, so PD patients may possibly be at a lower cardiovascular risk [14].…”