Clinical Study Of Cardiac Valve Calcification In Patients With End-Stage Renal Disease

Objective: To analyze the risk factors of cardiac valve calcification(CVC)in patients with end-stage renal disease(ESRD),and construct a risk scoring tool in order to early identify and predict the risk of CVC in ESRD patients.Methods: This study was a retrospective study that collected and reviewed the clinical data of ESRD patients treated in the First Affiliated Hospital of Guangxi Medical University from January 1,2014 to December 31,2016.Followup was conducted from the start of maintenance dialysis until March 31,2021,and the end point was CVC occurred in cardiac ultrasound.We divided patients into CVC group and non-CVC group according to whether CVC was occurred in cardiac ultrasonography during the follow-up period,and compared the differences between the data of two groups.Whereafter,we further separated the patients with CVC of AVC group and non-AVC group according to the presence of aortic valve calcification(AVC),and then compared the differences between the two groups.Subsequently,we investigated the independent risk factors for CVC and AVC respectively by multivariate COX regression analysis,performed subgroup analysis of risk factors and drew forest graphs.A risk scoring tool for CVC in ESRD patients was built according to the regression coefficient from multivariate COX stepwise regression analysis model and evaluated by timedependent receiver operating characteristic curve(ROC).Results: Of 244 patients,142 were males,102 were females,with a male-tofemale ratio of 1.39 to 1and an average age of 50.73±13.22 years old.The median follow-up time was 64.73 months.A total of 101 patients occurred CVC,with an incidence of 41.4%.Among them,aortic valve calcification happened to 75patients(74.3%).The multivariate stepwise COX regression analysis showed that age(HR=1.039),whether suffer from diabetes(HR=1.660),serum albumin levels(HR=0.922),hypersensitive c-reactive protein(hs-CRP)(HR=1.005),the calcium-phosphorus products(HR=1.227),intact parathyroid hormone(i PTH)(HR=1.000),serum calcium(HR=3.640),25(OH)vit D3(HR=1.012)were independent risk factors for CVC in patients with ESRD(all P<0.05),and taking non-calcium phosphate binders(HR=0.223)was its protective factor.Moreover,the result reflects that age(HR=1.042),the platelet-to-lymphocyte ratio(PLR)(HR=1.001),alkaline phosphatase(ALP)(HR=1.002),cystatin-C(Cys-C)(HR=1.184),body mass index(BMI)(HR=0.892)were independently related to the occurrence of AVC in ESRD patients(all P<0.05).The forest map of subgroup analysis indicated that the risk of CVC in ESRD patients was significantly increased when they suffered from diabetes or their age ≥60 years old,serum ALB levels<30g/L,the calcium phosphorus products≥5.65,hs-CRP≥5 mg/L,i PTH≥1000pg/ml(all P<0.05),and the risk decreased when they took noncalcium phosphorus binders(P<0.001).A risk scoring tool was built on the basis of the coefficient of multivariate COX regression model,and was evaluated by the time-dependent ROC curve analysis,which showed that Harrell’s C statistic of the risk score was 0.813,and the area under the curve(AUC)for predicting CVC in 1,3,and 5 years was 0.772,0.836 and 0.866,respectively.Conclusion: 1.The incidence of CVC is high in patients with ESRD,and AVC is the most common among them.2.Age,whether suffer from diabetes,the calcium-phosphorus products,low serum albumin,i PTH,25(OH)vit D3,and hsCRP are independent risk factors,and taking non-calcium phosphate binders is protective factor for CVC in patients with ESRD.3.The risk scoring tool based on the above independent risk factors is helpful to early assess the risk probability of CVC in ESRD patients within 5 years.