| Objective: To investigate the chronic kidney disease-mineral and bone abnormalities(CKD-MBD) prevalence and risk factors of maintenance hemodialysis(MHD) patients of 14 blood purification center in Sichuan region;Observation the relationship of serum soluble Klotho protein(s KL), fibroblast growth factor 23(Fibroblastgrowthfaetors23, FGF23) between abdominal aortic calcification and bone mineral metabolism in each index,To investigate their role in the diagnosis of vascular calcification, provide the basis for mitigation hemodialysis patients with cardiovascular events and improve the quality of life of patients.Methods: A total of 1150 hemodialysis patients of 14 dialysis centers in Sichuan region,Collected patient clinical data, echocardiography, pelvic anteroposterior film, abdominal radiographs examination,blood, pre-dialysis and kidney function, electrolytes, C-reactive protein, intact parathyroid hormone(i PTH) and ferritin(FER) before the inspections within three months.Taking patients blood 10 ml before dialysis to detect serum 25-hydroxyvitamin D(25(OH) D), FGF-23 and serum soluble klotho protein(s KL).Statistics Status of CKD-MBD indicators,Then were based on serum calcium, phosphorus, PTH situation further subgroup of patients, comparative analysis of the situation of the indicators in each group respectively,and analyzed the risk factors of CKD-MBD individual indicators.And analyze the correlation of FGF-23, s KL,calcium, phosphorus, i PTH, 25(OH) D and cardiovascular calcification.Evaluation the MHD patients of FGF-23, s KL, 25(OH) D diagnostic accuracy for cardiovascular calcification with receiver operating characteristic area under the curve(ROC).Results: 1. 610 male patients, 540 female patients, mean age was 54 ± 14 years. Patients diagnosed with CKD-MBD were 1113 cases(96.78%).Hypophosphatemia 90cases(7.80%), hyperphosphatemia 643 cases(55.90%); hypocalcemia 361 cases(31.40%), hypercalcemia of 326 cases(28.30%), low PTH 198 cases(17.20%), high PTH 671 cases(58.30%);Heart valve calcification in 169 patients(30.02%); abdominal aortic calcification in patients with 168(45.41%); iliac and femoral artery calcification in 106 cases(27.46%).Patients with serum calcium, phosphorus, serum PTH treatment compliance rates were 36.78%, 36.30%,24.50%.Age, SGA score, 25(OH)D were independent risk factors for hypophosphatemia;Systolic blood pressure, serum creatinine, blood urea nitrogen, high-density lipoprotein,i PTH were independent risk factors for hyperphosphatemia.Dialysis duration, PTH, FGF23 were independent risk factors for hypercalcemia.Serum creatinine, calcium were independent risk factors of low blood i PTH; phosphorus, albumin, alkaline phosphatase(ALP) were independent risk factors of high i PTH.2. Serum FGF-23 was positively correlated with serum P(rs = 0.239, P <0.05), positively correlated with i PTH(rs = 0.156, P <0.05); FGF-23 and Klotho were negatively correlated(rs =-0.086, P <0.05); FGF-23 and 25(OH) D3,25(OH) D were not correlation(P> 0.05).Serum Klotho was negatively correlated with serum P(rs =-0.067, P <0.05),and had no correlated with serum i PTH, 25(OH) D3,25(OH) D(P> 0.05). 3. 370 people take abdominal radiographs, abdominal aortic calcification where 168 cases(45.41%), 202 patients without vascular calcification(54.59%);Multivariate Logistic regression analysis, advanced age and dialysis duration were independent risk factors for abdominal aortic calcification.AAC integral and 25(OH) D3 was negatively correlated(rs =-0.122, P = 0.032),no correlation with FGF-23, Klotho, 25(OH) D(P> 0.05).FGF-23, Klotho, 25(OH) D predicted aortic calcifications AUCROC were 0.474(P = 0.397), 0.489(P = 0.717), 0.536(P = 0.250), represent serum FGF-23, Klotho, 25(OH) D diagnosis of abdominal aortic calcification had no specificity and sensitivity. 4. 563 patients take echocardiography, in which the number of heart valve calcification was 169(30.02%), 394 patients had no valve calcification(69.98%). Multivariate Logistic regression analysis, age, high dialysis age, lower diastolic blood pressure, large pulse pressure, and high C-reactive protein(CRP) were independent risk factors for heart valve calcification.Heart valve calcification was no correlation with serum FGF-23, Klotho, 25(OH) D(P> 0.05).FGF-23, Klotho, 25(OH)D predicted aortic calcifications AUC ROC were 0.480(P = 0.489), 0.540(P = 0.173), 0.513(P = 0.644), represents serum FGF-23, Klotho, 25(OH) D had no specificity and sensitivity to diagnosis of heart valve calcification. 5. 386 patients take pelvic anteroposterior film, in which the number of iliac artery calcification is 106(27.46%); no vascular calcification in patients with 280(72.54 percent).Multivariate Logistic regression analysis, age, pulse pressure large, high ALP, high neutrophils, high calcium and low 25(OH) D were independent risk factors for pelvic iliac artery calcification.Iliac artery calcification was negatively correlated with serum 25(OH) D3,25(OH) D(rs =-0.103,-0.135, P <0.05); iliac and femoral arteries calcification were no correlation with serum FGF-23, Klotho(P > 0.05).25(OH) D3,25(OH) D, FGF-23, Klotho forecast iliac artery calcification occured AUCROC were 0.567(P <0.05), 0.587(P <0.05), 0.508(P = 0.823), 0.492( P = 0.813);It represents serum FGF-23, Klotho were no specificity and sensitivity to diagnosis iliac artery calcification. 6. 220 patients take echocardiography, pelvic anteroposterior film, abdominal radiographs, including cardiovascular calcification 120 cases(55.50%); no calcification 100 cases (45.50%).Multivariate Logistic regression analysis, a low concentration of Klotho was the independent risk factor for cardiovascular calcification. 25(OH) D3,25(OH) D were positively correlated with Cardiovascular calcification(rs = 0.176,0.185, P <0.05); and Klotho was negatively correlated with Cardiovascular calcification(rs =-0.465, P <0.05); and Cardiovascular calcification was no correlation with FGF-23(P> 0.05).25(OH)D3,25(OH)D predict cardiovascular calcification occured AUCROC were 0.394,0.392,0.560, the area under the ROC curve were <0.6 indicates serum 25(OH)D3,25(OH)D,FGF-23 were no specificity and sensitivity to diagnosis cardiovascular calcification.But the AUROC of Klotho predicts cardiovascular calcification was 0.770(P <0.05), it presents Klotho predicts cardiovascular calcification have statistically significant.Conclusion: 1.MHD patients are high prevalence with CKD-MBD in Sichuan area; phosphorus, calcium, serum PTH treatment compliance rate; 2.Systolic blood pressure, serum creatinine, urea nitrogen, high-density lipoprotein, i PTH are independent risk factors for hyperphosphatemia.Dialysis duration, PTH, FGF23 are independent risk factors for high blood calcium.Phosphorus, albumin, alkaline phosphatase(ALP) are independent risk factors for high blood i PTH.Age, duration of dialysis, pulse pressure, CRP, serum klotho protein are risk factors for vascular calcification. 3.Serum FGF-23, Klotho are associated with abnormal bone mineral metabolism of MHD patients. 4.Low concentrations of serum s KL made the risk of cardiovascular calcification increased, serum s KL may be used as diagnosis of cardiovascular calcification serological markers. |
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