Study On Correlation Between Carotid Intima-media Thickness With Serum HsCRP, FGF23and Klotho Protein In Maintenance Hemodialysis Patients

OBJECTIVE To understand the clinic feature of the maintenance hemodialysis(MHD) patients with carotid artery atherosclerosis, analyze the relationship between carotid intima-media thickness(CIMT) and serum high sensitive c-reactive protein(HsCRP), fibroblast growth factor23(FGF23), Klotho protein levels.METHODS88MHD patients were enrolled in the blood purification center, Beijing Hospital of the Ministry of Health, from January to June2012. The patients were divided into CIMT thickening group and the CIMT normal group based on their carotid color Doppler ultrasound results. FGF23and Klotho protein were detected by using double antibody sandwich enzyme-linked immunosorbent assay (ELISA). Possible risk factors of CIMT thickening, such as age, gender,duration of dialysis, diabetes, combination therapy, blood pressure before and after dialysis, FGF23, Klotho protein, hsCRP, lipids and other biochemical and immune parameters were analyzed and compared between the two groups, while non-conditional logistic regression were used for multivariate analysis to determine the risk factors for CIMT thickening.RESULTS Among the88MHD patients, increased CIMT was found in53patients (60.2%), while the remaining35patients (39.8%) had normal CIMT. The median of the two sets of CIMT were1.5mm and1.0mm respectively, and the difference between the two groups was statistically significant (P=0.000). The incidence of atherosclerotic plaque in the group with increased CIMT was significantly higher than the group with normal CIMT (92.5%vs.65.7%, P=0.001) Univariate analysis indicated that the average age of the CIMT thickened group was66.64±10.61years, and the average age of the group with normal CIMT was58.63±11.78years, the difference was statistically significant (t=3.320, P=0.001); Diabetes prevalence of the CIMT thickened group was37.7%, Diabetes prevalence of the group with normal CIMT was17.1%, the difference was statistically significant (χ2=4.294, P=0.038); The median of the two sets of FGF23were127.82ng/L and86.74ng/L respectively, the difference was statistically significant (Z=-3.713, P=0.000); The median of the two sets of HsCRP were5.34mg/L and2.19mg/L respectively, the difference was statistically significant (Z=-3.547, P=0.000); The median of the two sets of Klotho protein were42.48U/L and41.21U/L respectively, the difference was not statistically significant (Z=-0.085, P=0.932). Non-conditional logistic regression analysis showed that age, FGF23and hsCRP were independent risk factors for CIMT thickening in MHD patients, OR values were1.061(1.007,1.118),1.016(1.003,1.028),1.344(1.115,1.621), respectively.CONCLUSION Thickened CIMT are prone to have more atherosclerosis plaque with MHD patients. Serum HsCRP, FGF23and age are independent risk factors for CIMT thickening in MHD patients.