Effect Of Malnutrition On Aortic Valve Calcification In Maintenance Hemodialysis Patients

Objective: The study aims to provide a reference for the prevention and treatment of aortic valve calcification in maintenance hemodialysis patients.Therefore,the study investigated the occurrence and severity of aortic valve calcification in maintenance hemodialysis patients with different malnutrition groups and analyzed the related factors of aortic valve calcification.Methods: From November 2020 to October 2021,170 patients with maintenance hemodialysis at First Affiliated Hospital of Shihezi University were enrolled.The clinical data and laboratory examination of all patients were collected in the study.According to the malnutrition-inflammation score,patients were divided into the mild malnutrition group,the moderate malnutrition group,the severe malnutrition group,and the normal nutrition group.The echocardiography and a semi-quantitative scoring system assessed the degree of aortic valve calcification,and recorded echocardiographic parameters.After that,the differences in clinical data,laboratory indicators,echocardiographic parameters,and aortic valve calcification between different groups were compared.Then the relationship between aortic valve calcification and factors was verified by Spearman correlation analysis.Finally,the binomial Logistic regression method was used to analyze the factors that may affect the aortic valve calcification and discussed the causality between malnutrition and aortic valve calcification.Multicollinearity among independent variables was explored using collinearity diagnostics.Results:(1)The majority of 170 maintenance hemodialysis patients were male(64.71%),and the average age was(59.20±15.56)years.The top three primary diseases in the group were primary glomerulonephritis(28.82%),diabetic nephropathy(28.24%),and hypertensive nephropathy(25.29%).(2)The study included 38 cases in the normal nutrition group,46 cases of mild malnutrition,43 cases of moderate malnutrition,and 43 cases of severe malnutrition were in group.In the study,64 cases have aortic valve calcification,including 27 cases of mild calcification,21 cases of moderate calcification,and 16 cases of severe calcification.(3)The difference in age(F=6.321,P<0.001),body mass index(H=32.904,P<0.001),body surface area(F=5.044,P=0.002),prealbumin(F=8.520,P<0.001),albumin(F=11.426,P<0.001),serum corrected calcium(F=8.900,P<0.001),the aortic valve calcification score(H=13.497,P=0.004),cardiac output(H=9.049,P=0.029),and cardiac index(H=13.497,P=0.004)were statistically significant among the four groups.(4)Spearman correlation analysis showed that aortic valve calcification was positively correlated with age(r=0.567,P<0.001),the degree of malnutrition(r=0.383,P<0.001),serum corrected calcium(r=0.272,P<0.001),the dialysis age(r=0.271,P<0.001),parathyroid hormone(r=0.218,P=0.004),C-reactive protein(r=0.188,P=0.014)and pulse pressure(r=0.167,P=0.030).Meanwhile,aortic valve calcification was negatively correlated with prealbumin(r=-0.318,P<0.001),albumin(r=-0.282,P<0.001),body mass index(r=-0.185,P=0.016),cardiac index(r=-0.166,P=0.030).(5)Passed the collinearity diagnosis,and further through multivariate Logistic regression analysis showed that patients were complicated by diabetes(OR=3.055,P=0.018),the degree of malnutrition(OR= 1.905,P=0.006),age(OR=1.096,P<0.001),and dialysis age(OR = 1.021,P=0.002)were the independent risk influencing factors of aortic valve calcification.Conclusion:(1)The incidence of aortic valve calcification in maintenance hemodialysis patients is higher than that in the general population.(2)In maintenance hemodialysis patients,aortic valve calcification was more likely to occur in elderly,long-term hemodialysis patients,severe malnutrition patients,and patients with diabetes.