The Analysis Of Factors Related To Cardiac Valve Calcification In Maintenance Hemodialysis Patients

Objective: Cardiovascular disease such as coronary artery disease,congestive heart failure,arrhythmias and sudden cardiac death is the most common complication in chronic kidney disease(CKD).CVC is associated with valve dysfunction,hypertension,myocardial ischemia,infective endocarditis,and heart failure.The prevalence of CVC is significantly higher in ESRD patients than the general population and is also a key factor impacting its prognosis.In addition,LVH can independently predict cardiovascular mortality in end-stage patients,the prevalence of LVH is as high as 75% in this group,and related studies have shown that the presence of LVH almost doubles the risk of sudden cardiac death.This purpose of this study was to explore the risk factors of CVC in patients with maintenance hemodialysis(MHD).It is hoped that the findings can provide clinical evidence for improving or delaying the progression of cardiac valve calcification in MHD patients.Early monitoring,prevention and treatment of CVC,thereby reducing the occurrence and death of cardiovascular events in patients with MHD,improve the quality of life of patients with MHD and prognosis.Methods: A total of 275 MHD patients(155 males and 120 females),23~87 years old(average age 57.82±14.55)treated in the Blood Purification Center,Tianjin Medical University Second hospital from September 2015 to September 2016 were retrospectively analyzed.They were treated with regular hemodialysis of 2-3times/week and 4 hours/time with the average dialysis age of(23.12±6.21)months.Evaluation of cardiac valve calcification was by echocardiography in all patients.Patients were divided into two groups based on the echocardiographic results,one as valve calcification group and the other as non-calcification group.In addition,valve calcification group were divided into two groups based on the number of valve calcification: group A as one valve calcification and group B as two valves calcification.Record two groups of demographic data.Collect the laboratory index such as Hb,Alb,UA,BUN,Cr,Ca,P,Ca×P,PTH,TC,TG,LDL-c,HDL-c,hs-CRP,and cardiac echocardiography examination results such as LAD,LVDS,LVDD,IVST,LVPWT,LVEF.The effects of gender,age,dialysis duration,hypertension,diabetes,anemia,nutritional status,inflammation,calcium and phosphorus metabolism,lipids,LVH,LVMI,and LVEF on CVC were analyzed.SPSS 20.0 statistical software was used for statistical analysis.Result:1.In the 275 patients,CVC was found in 132 patients(48.0%),in which AVC was found in 66 patients(24.0%),MVC in 3 patients(1.1%),and both aortic and mitral valve calcification in 63 patients(29%).143 patients(52.0%)had no cardiac valve calcification.2.Patients in the CVC group had older age,longer dialysis duration,higher systolic BP,and higher rates of diabetes(P < 0.05);the difference in diastolic BP was not statistically significant(P > 0.05).3.Patients in the CVC group had higher rates of LVH,larger LAD,higher LVMI,lower EF(P < 0.05);the differences in LVDs and LVPWT between two groups were not statistically significant(P > 0.05).4.Patients in the CVC group had higher level of Ca and hs-CRP,lower Alb(P <0.05);the differences in Hb,Cr,Urea,UA,P,Ca×P,PTH,TC,TG,HDL-c and LDL-c between two groups were not statistically significant(P > 0.05).5.Patients in the two valves calcification group had longer dialysis duration,higher LVMI,lower LVEF,higher rates of diabetes(P < 0.05);the differences in gender,age,systolic BP,LVH,LAD,LVDs,Alb,Ca,and hs-CRP between two groups were not statistically significant(P > 0.05).6.Multivariate Logistic regression analysis showed that age,dialysis duration,systolic BP and lower Alb level were the independent risk factors for CVC in MHD patients(P<0.05).Conclusion:1.CVC is prevalent in MHD patients,especially AVC.2.Age,dialysis duration,systolic BP and lower albumin level were the independent risk factors for Cardiac valve calcification in maintenance hemodialysis.3.Patients with cardiac valve calcification in maintenance hemodialysis had higher rates of left ventricular hypertrophy,lower LVEF levels and higher LVMI levels.When aortic and mitral valve were calcified,LVMI levels were higher.