A case-control study of calciphylaxis in Japanese end-stage renal disease patients
A case-control study of calciphylaxis in Japanese end-stage renal disease patients
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DOI：
10.1093/ndt/gfr658
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发表时间：
2012-04-01
影响因子：
6.1
通讯作者：
Sato, Yuji
中科院分区：
文献类型：
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作者：
Hayashi, Matsuhiko;Takamatsu, Ichiro;Sato, Yuji
背景。钙化反应，也称为钙化性尿毒症小动脉病，是一种罕见的终末期肾病并发症，通常是致命的，其特征是皮肤溃疡、坏死、内侧钙化和小动脉内膜增生。西方国家的研究报告慢性血液透析患者的发病率从1%到4%不等。由于在日本没有对钙化反应进行过系统的研究，我们进行了一项全国调查和病例对照研究，以确定日本透析人群中钙化反应的特征。首先，我们向日本3760个血液透析中心发送问卷，询问过去是否遇到过钙化反应病例，并从中心收集每个病例的详细临床资料。此外，在参与中心确定了两名与每个钙化反应病例年龄和血液透析时间相匹配的对照透析患者，并对他们的数据进行分析，以确定钙化的危险因素。调查问卷来自1838个中心（48.3%），其中151个中心报告共遇到249例病例。64个中心同意参与病例对照研究，并获得了67例病例的详细临床资料。在67例中的28例中，我们的研究组根据临床特征和皮肤活检结果做出了明确的钙化反应诊断。单因素logistic回归模型将他们与56个匹配的对照组进行比较，发现华法林治疗[比值比（OR） 11.4, 95%可信区间（CI）] 2.7-48.1, P = 0.0009]，血清白蛋白水平每下降1 g/dL (OR 19.8, 95% CI 4.4-89.5, P = 0.0001)，血浆葡萄糖水平每增加100 mg/dL (OR 3.74, 95% CI 1.08-12.9, P = 0.037)，调整后的血清钙水平每增加1 mg/dL (OR 3.2, 95% CI 1.63-6.30)，P = 0.0008)，但与女性性别、维生素D类似物治疗、血清磷酸盐水平、调整后的磷酸钙产物或血清碱性磷酸酶水平无显著相关性。经多因素logistic回归模型分析，华法林治疗和血清白蛋白水平降低仍是显著的危险因素。本研究结果表明，华法林治疗和较低的血清白蛋白水平是日本慢性血液透析患者发生钙化反应的重要且强烈的危险因素。
Background. Calciphylaxis, also called calcific uremic arteriolopathy, is a rare and often fatal complication of end-stage renal disease and is characterized by painful skin ulceration, necrosis, medial calcification and intimal proliferation of small arteries. Studies in western countries have reported incidences ranging from 1 to 4% in chronic hemodialysis patients. Since no systematic studies of calciphylaxis have ever been performed in Japan, we conducted a nationwide survey and a case-control study to identify the characteristics of calciphylaxis in the Japanese dialysis population.Methods. Firstly, we sent a questionnaire to 3760 hemodialysis centers in Japan, asking whether calciphylaxis cases had been encountered in the past, and detailed clinical data regarding each case were then collected from the centers. In addition, two control dialysis patients matched for age and duration of hemodialysis to each calciphylaxis case were identified at the participating centers, and their data were analyzed to identify risk factors for calciphylaxis.Results. Responses to the questionnaire were obtained from 1838 centers (48.3%), and 151 centers reported that a total of 249 cases had been encountered. Sixty-four centers agreed to participate in the case-control study, and detailed clinical data in regard to 67 cases were obtained. In 28 of the 67 cases, a definite diagnosis of calciphylaxis was made by our study group based on the clinical characteristics and skin biopsy findings. A univariate logistic regression model comparing them with 56-matched controls identified warfarin therapy [odds ratio (OR) 11.4, 95% confidence interval (CI)] 2.7-48.1, P = 0.0009], each 1 g/dL decline in serum albumin level (OR 19.8, 95% CI 4.4-89.5, P = 0.0001), each 100 mg/dL increment in plasma glucose level (OR 3.74, 95% CI 1.08-12.9, P = 0.037) and each 1 mg/dL increment in adjusted serum calcium level (OR 3.2, 95% CI 1.63-6.30, P = 0.0008) at the time of diagnosis as significantly associated with calciphylaxis, but no significant associations were found with female gender, vitamin D analog therapy, serum phosphate level, adjusted calcium-phosphate products or serum alkaline-phosphatase level. Warfarin therapy and lower serum albumin levels were still significant risk factors after a multivariate logistic regression model analysis.Conclusion. The results of this study showed that warfarin therapy and lower serum albumin levels are significant and strong risk factors for the development of calciphylaxis in chronic hemodialysis patients in Japan.