Influencing Factors Of Cardiac Valve Calcification In Non-Dialysis Patients With Chronic Kidney Disease Stage 3-5

Objective:To explore the incidence,influencing factors of cardiac valve calcification(CVC)in chronic kidney disease(CKD)non-dialysis patients.Methods:This study first explores the incidence of CVC and its correlation with CKD progress;Secondly,patients with CKD stage 3-5 were divided into non-CVC group and CVC group.The gender,age,smoking history,drinking history,hypertension history,diabetes history,hemoglobin concentration,red blood cell distribution width,platelet,serum albumin,serum uric acid,carbon dioxide binding capacity,corrected calcium,serum phosphorus,total cholesterol,triglyceride,cholesterol,low-density lipoprotein cholesterol and high-density lipoprotein in non-CVC group and CVC group were compared.On the basis of the above univariate analysis,the measurement data with significant differences in the above analysis are binarized,and the logistic model is established for the binarized variables and the selected classified variables,and the independent risk factors are established.Then,according to the logistic model,the ROC curve of CKD3-5 with CVC is drawn,and the area under the curve is calculated to evaluate the advantages and disadvantages of the model.Results:(1)A total of 834 patients were included in this study,including 599 patients in the non-valvular calcification group and 235 patients in the valvular calcification group.The incidence of valvular calcification was 28.2%.In the valve calcification group,there were 186 cases of simple aortic calcification(79.1%),34 cases of aortic calcification combined with mitral calcification(14.5%),14 cases of simple mitral calcification(6.0%)and 1 case of mitral calcification combined with tricuspid calcification(0.4%).The most common cardiac valve calcification was aortic calcification.The calcification rate in different stages of CKD:9.5% in patients with CKD1-2,22.2% in patients with CKD3,30.6% in patients with CKD4 and 37.8% in patients with CKD5.The trend chi-square test showed that chi-square value=31.485,P<0.001,suggesting that with the progress of CKD,the calcification rate of heart valves gradually increased,especially after the end stage.(2)Compared with the non-CVC group,the proportion of patients with hypertension and diabetes in CVC group was significantly higher,and the difference was statistically significant(P< 0.05).There was no significant difference in gender,smoking and drinking history between the two groups(P> 0.05).Age and laboratory indicators: The serum phosphorus,parathyroid hormone,fibrinogen,RDW and the ratio of neutrophils to lymphocytes in patients in non-CVC group were significantly lower than those in CVC group,with statistical significance(P< 0.05).The hemoglobin,serum albumin and high-density lipoprotein of patients in non-CVC group were significantly higher than those in non-CVC group(P< 0.05).There was no significant difference in uric acid,blood calcium,carbon dioxide binding capacity,cholesterol,triglyceride and low density lipoprotein between the two groups(P> 0.05).(3)Multivariate Logistic regression analysis showed that age ≥55 years(OR8.448,95%CI 5.562-12.831,P< 0.001)and serum phosphorus ≥ 1.55 mmol/L(OR 3.09,95%CI 1.987-4.805,P< 0.001).95% CI 2.537-6.050,P < 0.001),RDW ≥ 13.8%(OR1.568,95%CI 1.333-1.845,P< 0.001),diabetes(OR 2.166,95% CI 1.457-3.219,P< 0.001).In patients with CKD3-5,the risk of heart valve calcification in patients over 55 years old is 8.448 times that in patients under 55 years old,and the risk of heart valve calcification in patients with blood phosphorus ≥1.55mol/L is 3.09 times that in patients with blood phosphorus < 1.55 mmol/L.The risk of heart valve calcification in patients with PTH≥200pg/ml is 3.918 times that in patients with PTH < 200 pg/ml,2.166 times that in patients with diabetes mellitus,and 1.568 times that in patients with RDW≥13.8%.Conclusion:(1)The incidence of CVC in non-dialysis patients with CKD was 28.2%,mainly due to aortic valve calcification,followed by main artery with mitral valve calcification;(2)With the development of CKD,the occurrence of CVC gradually increased,and the rate of CKD5 reached 37.8%;(3)Age≥55 years old,blood phosphorus≥1.55mmol/L,PTH≥200pg/ml,RDW≥13.8% and diabetes mellitus were the independent risk factors for CVC in patients with CKD stage 3-5.