Cross-sectional association of serum phosphate with carotid intima-medial thickness in hemodialysis patients
Cross-sectional association of serum phosphate with carotid intima-medial thickness in hemodialysis patients
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DOI：
10.1053/j.ajkd.2005.02.008
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发表时间：
2005-05-01
影响因子：
13.2
通讯作者：
Nishizawa, Y
中科院分区：
文献类型：
--
作者：
Ishimura, E;Taniwaki, H;Nishizawa, Y
背景：尽管血磷浓度升高是血管钙化的重要危险因素，但尚不清楚血磷水平是否是血液透析患者动脉壁厚度增加的危险因素。方法：应用B型超声检测血液透析患者颈动脉内膜-中层厚度(IMT)，并结合血磷的影响分析IMT增厚的危险因素。入选血液透析患者716例(非糖尿病患者547例，糖尿病患者169例；男性441例，女性275例；年龄60±8.5岁)。结果糖尿病患者颈动脉内中膜厚度明显大于非糖尿病患者(0.859±0.250比0.783±0.178 mm；P<；0.0001)。在所有患者中，颈动脉内膜中层厚度与血磷水平相关性较弱，但显著(r=0.093；P=0.0127)。在对所有患者的多元回归分析中，血磷水平较高(0=0.166；P<；0.0001)被显示为颈动脉内膜中层厚度增加的显著独立危险因素，此外还有其他显著的独立危险因素，包括高龄、较高的血压、较高的非高密度脂蛋白胆固醇水平和糖尿病的存在(R2=0.1119；P<；0.00001)。在对非糖尿病和合并糖尿病的血液透析患者分别进行的多元回归分析中，较高的磷酸盐水平和高龄是IMT增加的显著独立危险因素，与其他混杂危险因素无关。结论：除高龄外，高血磷水平是糖尿病血液透析患者和非糖尿病血液透析患者动脉硬化的重要独立相关因素，提示血透患者应适当控制血磷水平，以防止动脉壁增厚。
Background: Although an increased serum phosphate concentration is a significant risk factor for vascular calcification, it is unclear whether serum phosphate level is a risk factor for increased arterial wall thickness in hemodialysis patients. Methods: Using B-mode ultrasonography, we examined intima-medial thickness (IMT) of the carotid artery of hemodialysis patients and analyzed risk factors for increased IMT with regard to the effect of serum phosphate. Seven hundred sixteen hemodialysis patients were enrolled (547 patients without diabetes, 169 patients with diabetes; 441 men, 275 women; age, 60 +/- 8.5 years). Results IMT of patients with diabetes was significantly greater than that of patients without diabetes (0.859 +/- 0.250 versus 0.783 +/- 0.178 mm;P < 0.0001). For the group of all patients, IMT correlated weakly, but significantly, with serum phosphate level (r = 0.093; P = 0.0127). In multiple regression analysis of the group of all patients, greater serum phosphate level (0 = 0.166; P < 0.0001) was shown to be a significant independent risk factor for Increased carotid IMT, in addition to other significant independent risk factors, including advanced age, higher blood pressure, greater non-high-density lipoprotein cholesterol level, and the presence of diabetes (R-2 = 0.1119; P < 0.00001). In multiple regression analyses performed separately for hemodialysis patients without and with diabetes, greater phosphate level and advanced age were significant independent risk factors for Increased IMT, independent of other confounding risk factors. Conclusion: These results show that in addition to advanced age, greater serum phosphate level is a significant and independent factor associated with advanced arteriosclerosis in hemodialysis patients with and without diabetes, suggesting that phosphate levels should be controlled appropriately to prevent an increase in arterial wall thickness In hemodialysis patients.