Assessment and significance of abdominal aortic calcification in chronic kidney disease
Assessment and significance of abdominal aortic calcification in chronic kidney disease
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DOI：
10.1093/ndt/gfp728
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发表时间：
2010-06-01
影响因子：
6.1
通讯作者：
Sasaki, Sei
中科院分区：
文献类型：
--
作者：
Hanada, Shigeru;Ando, Ryoichi;Sasaki, Sei
背景。腹主动脉钙化是透析患者常见的并发症，也是心血管疾病死亡率的预测因子。然而，腹主动脉钙化在透析前慢性肾脏疾病（CKD）中的作用尚不清楚。对101名日本成人透析前CKD患者（平均年龄66.6 +/- 11.3岁）（分别为3,4和5期18,29和54）进行了队列研究。入路时，采用非对比计算机断层扫描确定腹主动脉钙化指数（Ad）。临床特征和实验室变量也进行了评估。随访时间平均为48个月。其中82%的受试者存在腹主动脉钙化（CKD 3期、4期和5期分别为50%、83%和91%），中位ACI为16.7%（分别为8.5%、20.0和21.4%）。多因素logistic回归分析发现，年龄、糖尿病的存在和肾小球滤过率（e-GFR）的降低是主动脉钙化存在（ACI> = 0%）和程度（ACI> = 20%）的独立预测因素。多因素Cox比例风险分析发现ACT 20%和糖尿病是CKD 4期和5期新发心血管事件的独立预测因素。GFR降低可能与腹主动脉钙化的存在和程度有关，高水平的钙化可能与透析前CKD的新生心血管事件有关，表明阐明CKD促进血管钙化的机制可能会改善透析前CKD患者的预后。
Background. Abdominal aortic calcification is a common complication and a predictor of cardiovascular mortality in dialysis patients. However, abdominal aortic calcification in pre-dialysis chronic kidney disease (CKD) is poorly understood.Methods. A cohort study of 101 adult Japanese patients (mean age 66.6 +/- 11.3 years old) with pre-dialysis CKD (18, 29 and 54 in stages 3, 4 and 5, respectively) was performed. At entry, a non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (Ad). Clinical characteristics and laboratory variables were also assessed. The patients were followed for a mean period of 48 12 months.Results. Among the subjects, 82% had abdominal aortic calcification (50, 83 and 91% for CKD stages 3, 4 and 5, respectively), and the median ACI was 16.7% (8.5, 20.0 and 21.4%, respectively). Multivariate logistic regression analyses identified older age, presence of diabetes and decreased estimated glomerular filtration rate (e-GFR) as independent predictors of the presence (ACI>0%) and extent (ACI >= 20%) of aortic calcification. Multivariate Cox proportional hazards analysis identified ACT 20% and diabetes as independent predictors for de novo cardiovascular events in CKD stages 4 and 5.Conclusion. Decreased GFR may be associated with the presence and extent of abdominal aortic calcification, and a high level of calcification may be associated with de novo cardiovascular events in pre-dialysis CKD, suggesting that elucidation of the mechanism through which CKD contributes to vascular calcification may lead to an improved prognosis in patients with pre-dialysis CKD.