| Objective:To investigate the status of residual renal function(RRF),serum Klotho protein and cardiac valve calcification in patients with maintenance hemodialysis(MHD),and to analyze the relationship between RRF,serum Klotho protein and CVC in patients with MHD.Method:1 Subjects : A total of 112 patients undergoing regular hemodialysis in our hospital from October,2019 to November,2019 were selected,including 63 males and 49 females.All patients were at least 3 months of dialysis age and at least 18 years of age.2 Clinical and laboratory data : Clinical data of all patients were collected,including age,sex,primary renal disease,starting time of dialysis and dialysis regimen.The elbow venous blood of all patients was collected before the second dialysis every week for the detection of hemoglobin,calcium,phosphorus and whole parathyroid hormone,and the serum Klotho protein level was determined by ELISA method.3 Detection and diagnostic basis of CVC:CVC of all patients was detected by Philips Ultrasound Diagnostic Instrument in the Ultrasound Department of our hospital,and one or more bright echoes of aortic valve,mitral valve or mitral valve ring over 1mm were defined as CVC.4 Grouping method : Patients were grouped according to their urine volume during the interdialysis period.Patients with urine volume at 24 h greater than or equal to 100 ml were classified as the group with residual renal function(RRF)(61cases),and patients with urine volume less than 100 ml at 24 h were classified as the group without residual renal function(NRRF)(51 cases).5 Statistical method : SPSS 25.0 statistical software was used for data analysis.Normal measurement data were expressed as mean ± standard deviation((?)±s),and t test was used for comparison between the two groups.Non-normal measurement data were expressed as M(1/4,3/4),and the two groups were compared by Mann-Whitney rank sum test.Enumeration data were expressed as percentage(%),and χ~2 test was used for comparison.Spearman correlation analysis was used for correlation analysis.The influencing factors of CVC were analyzed by binary Logistic regression.Results:1 Data analysis of MHD patients Among the 112 MHD patients,there were 63 males(56.3%)and 49 females(43.7%),average age(59.16±14.37)(21-93)years old,average dialysis age(42.57±37.17)(3-198)months,serum Klotho protein level(62.04±35.48)(10.46-165.60)pg/m L,41 patients with CVC(36.6%)and 71 patients without CVC(63.4%).2 General data and clinical indicators of RRF group and NRRF group were analyzed61 patients in the RRF group of MHD,including 35 males and 26 females,had an average age of(60.2±12.9)(31-93)years old,and an average dialysis age of(32.8±31.9)(3-156)months.In the NRRF group,there were 51 patients,including 28 males and 23 females,with a mean age of(57.9±16.0)(21-84)years and a mean dialysis age of(54.3±39.9)(3-198)months.There were no significant differences in age,sex,Hb,P,Scr,BUN and Alp between 2 groups(P > 0.05).There were significant differences in serum Klotho,Ca,Ca*P,iPTH,ALB and dialysis age indexes between RRF group and NRRF group(P< 0.05):The serum Klotho protein of RRF group(68.13±38.07)pg/m L was higher than that of NRRF group(54.76±30.91)pg/m L(P < 0.05);Ca in RRF group(2.13±0.23)mmol/L was lower than that in NRRF group(2.23±0.26)mmol/L(P <0.05);Ca*P(3.58±1.17)mmol~2/L~2 in RRF group was lower than that in NRRF group(4.17±1.35)mmol~2/L~2(P < 0.05);iPTH [194.00(124.75,310.00)]pg/m L in RRF group was lower than that in NRRF group [271.30(200.50,420.03)]pg/m L(P < 0.05);The ALB of RRF group(36.08±4.51)g/L was lower than that of NRRF group(38.30±4.82)g/L(P < 0.05);The dialysis age of RRF group(32.79±31.87)months was lower than that of NRRF group(54.28±39.90)months(P < 0.05).3 CVC status of RRF group and NRRF group There were 11 cases of CVC in the RRF group(18.0%),and 30 cases of CVC in the NRRF group(58.8%).The incidence of CVC in the RRF group was significantly lower than that in the NRRF group(P < 0.05).4 Correlation analysis of CVC in MHD patients There was a negative correlation between CVC and serum Klotho protein level(r=-0.264,P < 0.05)and RRF(r=-0.422,P < 0.05)in MHD patients.It was positively correlated with serum Ca(r=0.195,P < 0.05),serum P(r=0.211,P < 0.05),Ca*P(r=0.249,P < 0.05),serum iPTH(r=0.266,P < 0.05),and dialysis age(r=0.382,P <0.05).There was no correlation with age,sex,Hb,Scr,BUN,ALb and Alp(P > 0.05).5 Analysis of the influencing factors of CVC in MHD patients With CVC as dependent variable,Klotho,RRF,age,gender,age of dialysis,Hb,Ca,P,iPTH,Scr,BUN,Alp and propagated by multiariable Logistic regression analysis for the independent variables,the results showed that serum Klotho protein levels and RRF is an independent protective factors of CVC(OR values were 0.982,0.261,95% CI value is 0.966 ～ 0.999,respectively,0.089 ～ 0.763,P values were0.042,0.014);Elevated serum phosphorus,increased iPTH and prolonged dialysis age(month)were independent risk factors for CVC(OR = 3.989,1.003,1.018,95%CI =1.179-13.491,1.000-1.005,1.003-1.034,P = 0.026,0.044,0.019).Conclusion:1 MHD patients have a higher incidence of CVC.2 RRF is a protective factor for CVC in MHD patients.RRF is associated with higher serum Klotho level and can reduce the incidence of CVC in MHD patients.3 Elevated serum Klotho level is a protective factor for CVC in MHD patients,and serum Klotho can prevent the occurrence of CVC and delay the progression of CVC.4 Higher blood phosphorus,iPTH and longer dialysis age were risk factors for CVC. |
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