| ObjectiveTo comprehend the impact and safety of dialysate on coronary artery calcification in patients undergoing maintenance hemodialysis and analyze the common risk factors that affect calcification of coronary artery in patients.MethodsScreening from the patients undergoing maintenance hemodialysis in blood purification center of our hospital who are divided into low-calcium hemodialysis group and high-calcium group,the former group using low-calcium dialysate of 1.25mmol/L of calcium ion concentration,while the latter group using 1.50mmol/L of calcium ion concentration.Two groups of patients underwent dialysis 3 times per week,for 3.5-4 hours each time,12 months of observation in all.Through spiral CT inspection,the Coronary artery calcification score(CACS)before and after treatment are then calculated.The general clinical data as well as common laboratory index before and after treatment are followed and collected.Extraction from Peripheral Venous Blood pre dialysis,isolate blood serum and detect the level of inflammatory factor IL-6、TNF-α as well as Total antioxidative capacity(TAC)、Total superoxide dismutase(T-SOD)、Malondialdehyde(MDA).Then conduct follow-up visit 、take recordings of the occurrence in hypertension、hypotension、muscle cramp and arrhythmia.To detect of atrium and ventricular inner diameter as well as Left ventricular ejection fraction(LVEF)、the maximum blood flow velocity ratio of early stage and end stage of diastole(E/Amax)through cardiac color Doppler ultrasound.Compare and analyze the difference in species number in CACS、cardiac function 、Oral calcium supplements 、Vitamin D preparations 、as well as hypotensive drugs between groups before and after treatment,in the meanwhile to investigate the occurrence of adverse drug reaction in term of hypertension,hypotension,muscle spasm,arrhythmia,etc.Analyze the risk factors that impact the coronary artery calcification in MHD patients by spearman correlation analysis and logistic regression analysis.Results174 cases of MHD patients hospitalized in the blood purification center are selected,among whom 90 male cases and 84 female cases,53.0±1.7 for average age.Before study there are no statistical significance in their age 、gender,protopathy diseases,dialysis age,body mass index,systolic pressure,diastolic pressure,blood calcium,CACS and ultraphonic throbbing measurement.Spiral CT inspection found that 124 cases with existing coronary artery calcification at the enrollment of group(occurrence rate 71.3%)。Through 12 months of treatment the CACS in both groups increased notably compared with before treatment,however the CACS level in low-calcium group is notably lower than high-calcium group at the end of study(491.0±785.3 VS 1164.5±1472.2,P<0.001)。Findings from comparison in cardiac functions among two groups of patients by the end of study showed : the cardiac E/Amax in low-calcium group is notably higher than that of high-calcium group(0.84±0.16 VS 0.70±0.10,P=0.039),but there is no statistical significance in LVEF discrepancy between two groups.Blood calcium level in low-calcium group is inferior to that in high-calcium group by the end of study(1.92±0.15 VS 2.25±0.14,P<0.001),the level of Intact parathyroid hormone(i PTH)is notably higher than in high-calcium group(472.4±189.2 VS 419.2±374.5,p=0.014),and the dosage of oral vitamine D or activated vitamin D are also higher than of high-calcium group(0.61±0.12 VS 0.42±0.23,p<0.001)。In the period of research,there are no statistical difference in the frequency of occurrence in term of hypertension,hypotension,muscle spasm and arrhythmia when carrying through dialysis.After analyzing the risk factors influencing coronary artery calcification and we reached that spearman correlation analysis showed the age 、body mass index(BMI)、systolic pressure have correlation with CACS.logistic regression analysis suggests there is significant correlation between the coronary artery calcification and their age for MHD patients(B=0.072,0R=1.075,p=0.001),but no correlation with the gender 、dialysis age 、body mass index、blood pressure、creatinine pre dialysis 、blood lipid、 serum IL-6、TNF-α、serum TAC、MDA、T-SOD,etc.ConclusionsThis study suggests long-term application of low-calcium dialysis with calcium ion concentration at 1.25mmol/L can effectively postpone the process of coronary arterial calcification,and contribute to maintain the diastolic function for patients,moreover it would not increase the risk factors of hypertension,hypotension,muscle spasm as well as arrhythmia,but for long run application it may reduce the blood calcium levels in patients and stimulate the rise in i PTH level,fortify the dosage of drugs administration in Vitamin D or activated Vitamin D.And this study reveals that the larger age is the major risk factor to coronary artery calcification for MHD patients. |
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