Objective To investigate the progression of abdominal aortic calcification (AAC) and its risk factors in maintenance hemodialysis (MHD) patients. Methods Forty-seven MHD patients treated in Beijing Jishuitan Hospital from December 2019 to April 2022 were enrolled in this study. Two lumbar quantitative CT images performed during the follow-up period were retrospectively reviewed; 8 slices were sequentially extracted, and AAC score was obtained by the Image J software. According to the average annual AAC-growth, the patients were divided into slow progression group (n=23) and rapid progression group (n=24), and then analyzed using univariate and multivariate regression methods. Results The median follow-up time was 2.15(2.14, 2.20) years, and 95.74% of the patients had the progression of AAC. The median baseline AAC score was 59.55 (20.03, 122.46), and the median follow- up AAC score was 78.25(31.93,141.92). Compared with the slow progression group, the rate of smoking (χ2=6.715, P=0.010), baseline AAC score (Z=-3.629, P＜0.001), time averaged serum phosphorus (t=-3.538, P=0.001), time averaged calcium and phosphorus product (t=-3.173, P=0.003), and time averaged intact parathyroid hormone (t=-3.060, P=0.004) were significantly higher, and the durations of oral sevelamer carbonate (Z=-2.122, P=0.034) and cinacalcet hydrochloride (Z= -2.880, P=0.004) were significantly longer in the rapid progression group. Multivariate logistic regression showed that baseline AAC score (OR=1.020, 95% CI: 1.006～1.035, P=0.005) and time averaged serum phosphorus (OR=115.585, 95% CI: 3.412～3915.747, P=0.008) were the risk factors for rapid progression of AAC in MHD patients. Conclusion AAC progresses rapidly in MHD patients. Higher baseline AAC score and hyperphosphatemia were the risk factors for rapid AAC progression in MHD patients.
[1] 陈爱群, 赵班, 徐冷楠, 等. 老年血液透析和腹膜透析患者的死亡原因分析[J]. 中华老年医学杂志, 2020, 39(9):1050-1054.
[2] Ritz E, Bommer J. Cardiovascular problems on hemodialysis: current deficits and potential improvement[J]. Clin J Am Soc Nephrol, 2009, 4(Supplement 1): S71-S78.
[3] Kdigo 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)[J]. Kidney Int Suppl (2011), 2017, 7(1): 1-59.
[4] Niu Q, Zhao H, Wu B, et al. Abdominal aortic calcification is superior to other arteries calcification in predicting the mortality in peritoneal dialysis patients – a 8?years cohort study[J]. Bmc Nephrol, 2019, 20(1): 439.
[5] Bai J, Zhang A, Zhang Y, et al. Abdominal aortic calcification score can predict all-cause and cardiovascular mortality in maintenance hemodialysis patients[J]. Ren Fail, 2023, 45(1): 2158869.
[6] Zhang H, Li G, Yu X, et al. Progression of vascular calcification and clinical outcomes in patients receiving maintenance dialysis[J]. Jama Netw Open, 2023, 6(5): e2310909.
[7] Krishnasamy R, Pedagogos E. Should nephrologists consider vascular calcification screening?[J]. Nephrology (Carlton), 2017, 22 Suppl 2: 31-33.
[8] Chen T, Yang J, Zuo L, et al. Relationship of abdominal aortic calcification with lumbar vertebral volumetric bone mineral density assessed by quantitative computed tomography in maintenance hemodialysis patients[J]. Arch Osteoporos, 2022, 17(1): 24.
[9] 郭玲, 安智峰, 宋杰. 维持性血液透析患者外周血骨钙素水平与腹主动脉钙化的关系研究[J]. 中国血液净化, 2023, 22(8):594-598.
[10] Maruyama N, Higuchi T, Ono M, et al. Correlation between aortic calcification score and biochemical parameters in hemodialysis patients[J]. Contrib Nephrol, 2019, 198: 40-51.
[11] Lackland D T, Elkind M S, D'Agostino R S, et al. Inclusion of stroke in cardiovascular risk prediction instruments: a statement for healthcare professionals from the American heart association/American stroke association[J]. Stroke, 2012, 43(7): 1998-2027.
[12] Agatston A S, Janowitz W R, Hildner F J, et al. Quantification of coronary artery calcium using ultrafast computed tomography[J]. J Am Coll Cardiol, 1990, 15(4): 827-832.
[13] Wang Y N, Sun Y, Wang Y, et al. Serum s100a12 and progression of coronary artery calcification over 4 years in hemodialysis patients[J]. Am J Nephrol, 2015, 42(1): 4-13.
[14] Kwon H Y, Lee O H, Kim M J, et al. The association between mortality and abdominal aortic calcification and relation between its progression and serum calcium concentration in chronic hemodialysis patients[J]. Kidney Res Clin Pract, 2014, 33(2): 95-102.
[15] Russo D, Corrao S, Miranda I, et al. Progression of coronary artery calcification in predialysis patients[J]. Am J Nephrol, 2007, 27(2): 152-158.
[16] Sigrist M K, Taal M W, Bungay P, et al. Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 and 5 chronic kidney disease[J]. Clin J Am Soc Nephrol, 2007, 2(6): 1241-1248.
[17] Block G A, Spiegel D M, Ehrlich J, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis[J]. Kidney Int, 2005, 68(4): 1815-1824.
[18] Kakani E, Elyamny M, Ayach T, et al. Pathogenesis and management of vascular calcification in ckd and dialysis patients[J]. Semin Dial, 2019, 32(6): 553-561.
[19] Kim J S, Hwang H S. Vascular calcification in chronic kidney disease: distinct features of pathogenesis and clinical implication[J]. Korean Circ J, 2021, 51(12): 961-982.
[20] Yao L, Sun Y, Sun W, et al. High phosphorus level leads to aortic calcification via β-catenin in chronic kidney disease[J]. Am J Nephrol, 2015, 41(1): 28-36.
[21] Tani M, Tanaka S, Takamiya K, et al. Effects of repetitive diet-induced fluctuations in plasma phosphorus on vascular calcification and inflammation in rats with early-stage chronic kidney disease[J]. J Clin Biochem Nutr, 2020, 66(2): 139-145.
[22] Katsumata K, Kusano K, Hirata M, et al. Sevelamer hydrochloride prevents ectopic calcification and renal osteodystrophy in chronic renal failure rats[J]. Kidney Int, 2003, 64(2): 441-450.
[23] 陈佩玲, 龚德华, 徐斌, 等. 维持性血液透析患者心血管钙化进展的相关影响因素分析[J]. 肾脏病与透析肾移植杂志, 2017, 26(05):403-407.
[24] Isaka Y, Hamano T, Fujii H, et al. Optimal phosphate control related to coronary artery calcification in dialysis patients[J]. J Am Soc Nephrol, 2021, 32(3): 723-735.
[25] Sheridan K, Logomarsino J V. Effects of serum phosphorus on vascular calcification in a healthy, adult population: a systematic review[J]. J Vasc Nurs, 2017, 35(3): 157-169.
[26] Kendrick J, Chonchol M. The role of phosphorus in the development and progression of vascular calcification[J]. Am J Kidney Dis, 2011, 58(5): 826-834.
[27] Nakayama K, Nakao K, Takatori Y, et al. Long-term effect of cinacalcet hydrochloride on abdominal aortic calcification in patients on hemodialysis with secondary hyperparathyroidism[J]. Int J Nephrol Renovasc Dis, 2013, 18(7): 25-33.
[28] Takei T, Otsubo S, Uchida K, et al. Effects of sevelamer on the progression of vascular calcification in patients on chronic haemodialysis[J]. Nephron Clinical Practice, 2008, 108(4): c278-c283.
