Mineral metabolism factors predict accelerated progression of common carotid intima-media thickness in chronic kidney disease: the NEFRONA study
Mineral metabolism factors predict accelerated progression of common carotid intima-media thickness in chronic kidney disease: the NEFRONA study
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DOI：
10.1093/ndt/gfw306
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发表时间：
2017-11-01
影响因子：
6.1
通讯作者：
Fernandez, Elvira
中科院分区：
文献类型：
--
作者：
Abajo, Maria;Betriu, Angels;Fernandez, Elvira
背景慢性肾脏病（CKD）过早死亡的主要原因是心血管疾病（CVD），但肾脏病患者的风险评估具有挑战性。该研究的目的是分析CKD队列中2年随访（2010 - 12）后预测颈总动脉内膜中层厚度（CCIMT）加速进展的因素。该研究纳入了来自NEFRONA队列的1152例CKD 3 - 5D期且无CVD临床病史的患者。在两侧颈总动脉远壁测量CCIMT。CCIMT进展定义为每侧基线和24个月时CCIMT之间的变化，平均并标准化为每年的变化。加速进展者定义为第75次CCIMT改变的患者。中位CCIMT进展率为0.0125 mm/年，CKD分期之间无显著差异。定义加速进展的临界值为0.0425 mm/年。调整后，年龄是所有CKD分期的共同因素。传统的心血管危险因素，如糖尿病和收缩压，是CKD 4 - 5期进展的预测因子，而高密度脂蛋白和低密度脂蛋白胆固醇预测3期女性的进展。预测加速进展的矿物质代谢因素为3期和5D期的血清磷; 4 - 5期的低25-羟基维生素D和甲状旁腺激素水平> 110 pg/mL; 5D期的全段甲状旁腺激素水平超出推荐范围。矿物质代谢参数可能预测CCIMT从早期CKD阶段加速进展。
Background. The leading cause of premature death in chronic kidney disease (CKD) is cardiovascular disease (CVD), but risk assessment in renal patients is challenging. The aim of the study was to analyse the factors that predict accelerated progression of common carotid intima-media thickness (CCIMT) in a CKD cohort after 2 years of follow-up (2010-12).Methods. The study included 1152 patients from the NEFRONA cohort with CKD stages 3-5D and without a clinical history of CVD. CCIMT was measured at the far wall on both common carotids. CCIMT progression was defined as the change between CCIMT at baseline and at 24 months for each side, averaged and normalized as change per year. Accelerated progressors were defined as those with a CCIMT change 75th percentile.Results. The median CCIMT progression rate was 0.0125 mm/year, without significant differences between CKD stages. The cut-off value for defining accelerated progression was 0.0425 mm/year. After adjustment, age was a common factor among all CKD stages. Traditional cardiovascular risk factors, such as diabetes and systolic blood pressure, were predictors of progression in CKD stages 4-5, whereas high-density lipoprotein and low-density lipoprotein cholesterol predicted progression in women in stage 3. Mineral metabolism factors predicting accelerated progression were serum phosphorus in stages 3 and 5D; low 25-hydroxyvitamin D and parathyroid hormone levels > 110 pg/mL in stages 4-5 and intact parathyroid hormone levels out of the recommended range in stage 5D.Conclusions. Mineral metabolism parameters might predict accelerated CCIMT progression from early CKD stages.