Mineral metabolism and vascular damage in children on dialysis
Mineral metabolism and vascular damage in children on dialysis
复制标题
DOI：
10.1681/asn.2006121397
复制
发表时间：
2007-11-01
影响因子：
13.6
通讯作者：
Rees, Lesley
中科院分区：
文献类型：
--
作者：
Shroff, Rukshana C.;Donald, Ann E.;Rees, Lesley
心血管疾病越来越多地被认为是年轻慢性肾脏疾病患者的一个限制生命的问题，但很少有儿童研究描述其决定因素。我们研究了85名5-18岁接受透析6个月的儿童完整甲状旁腺激素(IPTH)水平及其对血管结构和功能的影响。与对照组相比，透析患者颈动脉内膜中层厚度和脉搏波速度增加。所有血管指标与血磷水平呈正相关，而颈动脉内膜中层厚度和心脏钙化积分也与iPTH水平相关。IPTH平均时间积分水平低于正常上限的两倍(n=41)的患者的血管测量与年龄匹配的对照组相似，但iPTH水平高于正常上限的两倍(n=44)的患者与对照组相比，颈动脉内中膜厚度更大，血管更硬，心脏钙化增加。颈动脉内膜-中层厚度增加的患者血管更硬，心脏钙化的发生率更高。维生素D与所有血管指标之间存在强烈的剂量依赖关系，而从磷酸盐粘合剂中摄取的钙与颈动脉内膜-中层厚度相关性较弱。总之，iPTH水平和维生素D的剂量都与透析儿童的血管损伤和钙化有关。
Cardiovascular disease is increasingly recognized as a life-limiting problem in young patients with chronic kidney disease, but there are few studies in children that describe its determinants. We studied the association of intact parathyroid hormone (iPTH) levels and their management on vascular structure and function in 85 children, ages 5-18 years, who had received dialysis for >= 6 months. Compared to controls, dialysis patients had increased carotid intima-media thickness and pulse-wave velocity. All vascular measures positively correlated with serum phosphorus levels, while carotid intima-media thickness and cardiac calcification score also correlated with iPTH levels. Patients with mean time-integrated iPTH levels less than twice the upper limit of normal (n = 41) had vascular measures that were comparable to age-matched controls, but those with iPTH levels greater than twice the upper limit of normal (n = 44) had greater carotid intima-media thickness, stiffer vessels, and increased cardiac calcification than controls. Patients with increased carotid intima-media thickness had stiffer vessels and a greater prevalence of cardiac calcification. There was a strong dose-dependent correlation between vitamin D and all vascular measures, and calcium intake from phosphate binders weakly correlated with carotid intima-media thickness. In conclusion, both iPTH level and dosage of vitamin D are associated with vascular damage and calcification in children on dialysis.