| Objective:Cardiovascular disease(CVD) is the leading cause of death in the end-stage renal disease(ESRD) patients,and vascular calcification is an important cause of cardiovascular disease.Recent studies have shown that the serum soluble Klotho(s KL) protein is related to disorders of mineral metabolism and vascular calcification in chronic kidney disease(CKD) patients.This study aims to understand the clinic feature of peritoneal dialysis(PD) patients with abdominal aortic calcification,and analyze the relationship between s KL and abdominal aortic calcification,and provide a theoretical basis for the early detection and assessment of cardiovascular disease.Methods:80 continuous ambulatory peritoneal dialysis(CAPD) patients,who dialysis regularly for more than 3 months,were collected prospectively.Abdomen lateral plain were used as a criteria to determine the abdominal aortic calcification.The abdominal aortic calcification score(AACs)was calculated.Patients were further divided into four groups according to quartiles of distribution range of serum s KL.55 cases of normal healthy adults were encrolled as the control group.Serum s KL and Fibroblastgrowth factor 23(FGF23) was detected by ELISA.Logistic regression analysis was used to determine the risk factor of moderate to severe abdominal aortic calcification in PD patients.The ROC analysis was applied to evaluate the diagnostic value of serum s KL in moderate to severe abdominal aortic calcification.Results:1 PD group and the healthy control group:There were 80 cases of peritoneal dialysis patients(male 38 cases,female 42 cases),with mean age(46.90±13.60).There were 55 cases of healthy controls(male 29 cases,female 26 cases),with average age(40.13±8.20).There was no statistical significance between the two groups in gender,age.The serum s KL of PD group were lower than the control groups,the difference was statistically significant[respectively(381.39 ± 48.99)pg/ml vs(478.85 ± 58.13)pg/ml,P <0.01].2 Abdominal aortic calcification:80 cases of PD patients,41(51.3%) patients had abdominal aortic calcification,20 cases had mild abdominal aortic calcification(0<AACs≤4),15 cases had moderate abdominal aortic calcification(5≤AACs≤15),and 6 cases had severe abdominal aortic calcification(AACs≥16).Among them,the calcification of 12 patients(29.3%) occurred in the first lumbar segment,14 patients(34.2%) occurred in the second lumbar segment,22 patients(53.7%) occurred in the third lumbar segment,24 patients(58.5%) occurred in the fourth lumbar segment,and calcification was most severe in front of the fourth lumbar segment,and ameliorated in higher lumbar levels.3 Patients were divided into four groups according to quartiles of distribution range of serum s KL:I group:s KL≤351pg/m L;II group:s KL352~376pg/m L;III group:s KL377~415pg/m L; Ⅳgroup:s KL≥416pg/m L.There was no statistical significance among the four groups in the clinical data,biochemical indicators,dialysis index,complications,medication history and FGF23,P>0.05.The AACs of I group and II group were higher than theⅣ group,the difference was statistically significant in different concentration groups,P<0.05.4 The relationship of serum s KL and AAC:Serum s KL level in moderate to severe calcified patient was lower than mild calcified patient,and the difference was statistically significant[respectively(357.20±46.25)pg/ml,(319.33±48.64)pg/ml vs(382.85±44.12)pg/ml,P<0.05].Univariate linearcorrelation analysis showed that the serum s KL was negatively correlated with AAC(r=-0.48,P<0.01),FBG(r=-0.22,P<0.05),hs-CRP(r=-0.30,P<0.01)and positively correlated with urine(r=0.23,P<0.05),there was no correlation with other factors.With the decreased of serum s KL levels,the proportion of high AAC score patients was also significantly increased.The proportion of moderate to severe calcified patient was significantly reduced,and no or mild calcified patient was significantly increased in Ⅳgroup(P<0.05).5 Analysis of risk factors affecting PD patients with moderate to severe abdominal aortic calcification:moderate to severe abdominal aortic calcification(AACs≥5 assigned to 1) as the dependent variable.Logistic regression analysis showed that lower serum s KL level(OR=0.966,95%CI0.945~0.988,P<0.01)and higher age(OR=1.097,95%CI 1.033~1.165,P<0.01) were independent risk factors for moderate to severe abdominal aortic calcification.Risk of moderate to severe abdominal aortic calcification in PD patients with lowest quartile of the s KL concentration was significantly higher than those with highest quartile after adjustment for demographic data,lifestyle factors and biochemical markers.6 The accuracy of serum s KL predict moderate to severe abdominal aortic calcification:ROC-AUC of serum s KL for moderate to severe abdominal aortic calcification was 0.800(95%C1 0.678~0.922,P<0.01),(cut off 361.5pg/ml,accuracy 71.4%,specificity 84.6%).Conclusions:The lower serum s KL is significantly associated with abdominal aorta calcification,it may play an important role in the mechanism of abdominal aortic calcification in PD patients.Serum s KL may have predict value for moderate to severe abdominal aorta calcification in PD patients. |
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