| Objectives:Study the relationship between abnormal calcium phosphorus metabolism andcardiovascular calcification in peritoneal dialysis and hemodialysis patients, theinfluence on prognosis of cardiovascular calcification in maintenance dialysis patients;Compare the difference and factors of aortic arch calcification in peritoneal dialysis andhemodialysis patients, and effects of different survival prognosis in dialysis patients.Methods:Select regular dialysis treatment for patients with CKD5in Shanghai No.6People’sHospital during peritoneal dialysis and hemodialysis treatment center from January1,2011to December31,2013. Collect general dialysis data, height, weight, bloodpressure, biochemical tests and other indicators, evaluate the dialysis adequacy andresidual renal function in patients, record chest X-ray and assessment of aortic archcalcification degree, record echocardiographic examination results, medication indialysis patients. Using the two variables Logistics regression analysis independent riskof cardiac valve calcification and aortic arch calcification factors; Using Kaplan-Meieranalysis the influence on prognosis of cardiovascular calcification in dialysis patients;Using multivariate COX regression analysis the independent risk factors for death riskin dialysis patients; Compare aortic arch calcification and prognosis in in peritonealdialysis and hemodialysis patients, Using Kaplan-Meier analysis effect of calcifiedaortic arch on prognosis by patients of different dialysis modalities. Results:Select177cases in peritoneal dialysis patients,50cases of cardiac valvecalcification (28.25%cases), mitral valve calcification in11cases, aortic valvecalcification in28cases, mitral valve and aortic valve calcification in11cases, aorticarch calcification in66cases (37.29%). Age and dialysis time are the independent riskfactors for cardiac valve calcification and aortic arch calcification in peritonealdialysis patients(P＜0.01). Serum phosphorus, calcium phosphorus product is inperitoneal dialysis patients with cardiovascular calcification were independent riskfactors. Serum phosphorus level>2.00mmol/L, cardiac valve calcification and aorticarch calcification incidence increased, Compared with≤1.50mmol/L, cardiac valvecalcification (OR=4.271,95%CI1.702-10.714, P=0.001), aortic arch Calcification(OR=10.235,95%CI,1.719-10.434, P=0.001); calcium phosphorus product＞4.20mmol2/L2, cardiac valve calcification and aortic arch calcification incidenceincreased, Compared with≤3.50mmol2/L2, cardiac valve calcification(OR=4.296,95%CI1.874-9.852, P=0.0000), aortic arch Calcification(OR=6.750,95%CI3.014-15.118, P=0.000). Calcium phosphorus product is a strong independentrisk factors for cardiac valve calcification (HR=2.739,95%CI1.578-4.755, P=0.000);Phosphorus is a strong independent risk factors for aortic arch calcification (HR=45.167,95%CI8.914-228.850, P=0.000). Cardiac valve and aortic arch calcification risk indiabetic nephropathy patients is respectively2.677and2.127times in patients with nondiabetic nephropathy. Cardiac valve calcification in patients survival rate wassignificantly lower than non-valve calcification (Log-rank=6.832, P=0.009); Moderate(severe) of aortic arch calcification patients survival rate was significantly lower thannon-calcification (Log-rank=12.035, P=0.002), the risk of death was24.429times ofnon-calcified cases (P <0.01).Select147cases in peritoneal hemodialysis patients, aortic arch calcification in88cases (59.86%). Calcium phosphorus product is a strong independent risk forhemodialysis patients with aortic arch calcification(HR=2.719,95%CI1.599-4.622,P=0.000). Calcium phosphorus product＞4.20mmol2/L2, aortic arch calcification incidence increased, Compared with≤3.50mmol2/L2, OR=7.467,95%CI3.306-16.863,P=0.000. Aortic arch calcification occurs in diabetic nephropathy risk is3.339times ofnon diabetic nephropathy. Moderate (severe) of aortic arch calcification patientssurvival rate was significantly lower than non-calcification (Log-rank=9.834, P=0.007),the risk of death was6.167times of non-calcified cases (P <0.01).At the time of dialysis13-36months, incidence of aortic arch calcification in PDcases lower than hemodialysis patients (33.60%vs55.60%, P=0.025); Residual renalfunction higher than hemodialysis cases (3.54+3.14ml/min vs1.92+1.38ml/min,P=0.012); Calcium phosphorus product lower than hemodialysis cases (4.09±1.06mmol2/L2vs4.75±1.36mmol2/L2， P=0.034). Incidence of moderate(severe)calcification of aortic arch in hemodialysis patients higher than PD cases (26.53%vs19.77%，OR=2.096，95%CI1.204-3.652，P=0.008). Moderate(severe) calcification ofaortic arch in hemodialysis patients survival rate was significantly lower thannon-calcification (Log-rank=9.834, P=0.007). At the time of dialysis13-36months, theprognosis is better than that of patients with peritoneal dialysis in hemodialysispatients(9.70%vs22.20%，P=0.034), Moderate(severe) calcification of aortic arch oneffects of peritoneal dialysis patients and hemodialysis patients had no obviousdifference between (Log-rank=2.938, P=0.086).Conclusions:High blood pressure, blood lipids, diabetes are the influence of the traditional riskfactors of cardiovascular calcification，abnormal calcium phosphorus metabolism is thefinal important risk factors of cardiovascular calcification in patients with end-stagerenal disease. Moderate(severe) calcification of aortic arch is an independent risk forall-cause mortality in continuous ambulatory peritoneal dialysis and hemodialysispatients, cardiac valve calcification is an independent risk for cardiovascular diseasemortality. Protection and slow the loss of residual renal function better by peritonealdialysis, the better to maintain levels of calcium and phosphorus is an important factorfor incidence of aortic arch calcification lower than hemodialysis patients.Moderate(severe) calcification of aortic arch is a strong risk factor for patients with ESRD dialysis mortality risk, but the risk effect on patients undergoing hemodialysisand peritoneal dialysis had no obvious difference. |
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