Risk Factors For Coronary Artery Calcification In Maintenance Hemodialysis Patients

ObjectiveTo analyze the risk factors associated with the occurrence and severity of coronary artery calcification(CAC)in maintenance hemodialysis patients.Subject and Methods.(1)In the first part,178 patients undergoing maintenance hemodialysis in Guangdong General Hospital from January 2018 to December 2020 were selected.The basic information and clinical indicators of the whole study population were retrospectively collected,and the levels of serum OPG,RANKL and FGF21 were detected by ELISA.Coronary artery calcification score(CACs)was measured.According to the CACs value,the patients were divided into severe calcification(CAC++),mild calcification(CAC+)and non-calcification(CAC-)groups.The general information,biochemical indexes,RANKL,OPG and FGF21 levels of each group were analyzed.(2)In the second part,104 patients admitted to hemodialysis Center of Guangdong General Hospital from June 2018 to June 2021 were enrolled.Standard deviation(SD)and coefficient of variation(CV)of Calcium(Ca),Phosphorus(P)and PTH during the study period(2 years)were calculated respectively.The influence of Ca,P and PTH variability on the occurrence and progression of CAC was evaluated.Result(1)In the first part of the study,the incidence of CAC in MHD patients was 79.2%,and the incidence of severe CAC(CACs>400)was as high as 54.5%.By comparing the CAC++group,CAC+group and CAC-group,The results showed that there were statistically significant differences in Age,dialysis Age,HbA1 and OPG levels between CAC++group and CAC-group.The above indexes were positively correlated with CACs(P<0.05),serum creatinine and diastolic blood pressure were negatively correlated with CACS;but there were no significant differences in RANKL and FGF21 levels among CAC++,CAC+and CAC(P>0.05).Multivariate logistic regression analysis showed that Age,dialysis Age and HbAlc and OPG were independent risk factors for the occurrence and progression of CAC.(2)The second part is about the variability of Ca,P and PTH:(1)According to the CACs value,the two groups were divided into CAC+group(CACs>10)and CAC-group(CACs<10).The comparative analysis showed that there were statistical differences in the variability of PTH(PTH-SD and PTH-CV)at Age,dialysis Age in both groups(P<0.05).Age(OR=1.1,95%CI 1.02～1.13,P=0.011),PTH-CV(OR=6.1,95%CI,1.6～22.6,P=0.007)were independent risk factors for CAC.(2)To further analyze the risk factors for the progression of CAC,104 patients were divided into severe calcification group(CAC+)and mild calcification group(CAC+)according to CACs>400.Single-factor logistics regression analysis found that Age,dialysis Age,PTH-SD and PTH-CV were risk factors related to the progression of CAC,suggesting that the above four indicators were related to the progression of CAC.After correcting Age and Age through chromatography,PTH-SD(OR=1.99,95%CI,1.23～2.34,P=0.048)and PTH-CV(OR=3.12,95%CI,1.35～5.68,P=0.005)were suggested as independent risk factors for the severity of CAC.Conclusions1.MHD patients have a high incidence of coronary calcification,and up to 50%of patients have developed severe coronary calcification.2.Age,dialysis age,HbAlc,OPG and PTH variability(SD and CV)were independent risk factors for the occurrence and severity of coronary artery calcification in MHD patients.