血清钙化倾向与 CKD 的临床事件。
Serum Calcification Propensity and Clinical Events in CKD.
机构信息
Department of Preventive Medicine.
Center for Translational Metabolism and Health, Institute for Public Health and Medicine, and.
出版信息
Clin J Am Soc Nephrol. 2019 Nov 7;14(11):1562-1571. doi: 10.2215/CJN.04710419. Epub 2019 Oct 28.
BACKGROUND AND OBJECTIVES
Patients with CKD are at high risk for cardiovascular disease, ESKD, and mortality. Vascular calcification is one pathway through which cardiovascular disease risks are increased. We hypothesized that a novel measure of serum calcification propensity is associated with cardiovascular disease events, ESKD, and all-cause mortality among patients with CKD stages 2-4.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among 3404 participants from the prospective, longitudinal Chronic Renal Insufficiency Cohort Study, we quantified calcification propensity as the transformation time (T) from primary to secondary calciprotein particles, with lower T corresponding to higher calcification propensity. We used multivariable-adjusted Cox proportional hazards regression models to assess the associations of T with risks of adjudicated atherosclerotic cardiovascular disease events (myocardial infarction, stroke, and peripheral artery disease), adjudicated heart failure, ESKD, and mortality.
RESULTS
The mean T was 313 (SD 79) minutes. Over an average 7.1 (SD 3.1) years of follow-up, we observed 571 atherosclerotic cardiovascular disease events, 633 heart failure events, 887 ESKD events, and 924 deaths. With adjustment for traditional cardiovascular disease risk factors, lower T was significantly associated with higher risk of atherosclerotic cardiovascular disease (hazard ratio [HR] per SD lower T, 1.14; 95% confidence interval [95% CI], 1.05 to 1.25), ESKD within 3 years from baseline (HR per SD lower T, 1.68; 95% CI, 1.52 to 1.86), and all-cause mortality (HR per SD lower T, 1.16; 95% CI, 1.09 to 1.24), but not heart failure (HR per SD lower T, 1.06; 95% CI, 0.97 to 1.15). After adjustment for eGFR and 24-hour urinary protein, T was not associated with risks of atherosclerotic cardiovascular disease, ESKD, and mortality.
CONCLUSIONS
Among patients with CKD stages 2-4, higher serum calcification propensity is associated with atherosclerotic cardiovascular disease events, ESKD, and all-cause mortality, but this association was not independent of kidney function.
PODCAST
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_10_28_CJN04710419.mp3.
背景和目的
患有 CKD 的患者心血管疾病、ESKD 和死亡率风险较高。血管钙化是增加心血管疾病风险的途径之一。我们假设一种新的血清钙化倾向衡量方法与 CKD 2-4 期患者的心血管疾病事件、ESKD 和全因死亡率相关。
设计、设置、参与者和测量：在来自前瞻性、纵向慢性肾功能不全队列研究的 3404 名参与者中，我们将钙化倾向量化为从初级到次级钙蛋白颗粒的转化时间（T），较低的 T 对应较高的钙化倾向。我们使用多变量调整的 Cox 比例风险回归模型来评估 T 与裁定的动脉粥样硬化性心血管疾病事件（心肌梗死、中风和外周动脉疾病）、裁定的心衰、ESKD 和死亡率的相关性。
结果
平均 T 为 313（SD 79）分钟。在平均 7.1（SD 3.1）年的随访期间，我们观察到 571 例动脉粥样硬化性心血管疾病事件、633 例心力衰竭事件、887 例 ESKD 事件和 924 例死亡。在调整传统心血管疾病危险因素后，较低的 T 与较高的动脉粥样硬化性心血管疾病风险显著相关（每降低 1 SD T 的风险比 [HR]，1.14；95%置信区间 [95%CI]，1.05 至 1.25）、ESKD 在基线后 3 年内（每降低 1 SD T 的 HR，1.68；95%CI，1.52 至 1.86）和全因死亡率（每降低 1 SD T 的 HR，1.16；95%CI，1.09 至 1.24），但与心力衰竭无关（每降低 1 SD T 的 HR，1.06；95%CI，0.97 至 1.15）。在调整 eGFR 和 24 小时尿蛋白后，T 与动脉粥样硬化性心血管疾病、ESKD 和死亡率的风险无关。
结论
在 CKD 2-4 期患者中，较高的血清钙化倾向与动脉粥样硬化性心血管疾病事件、ESKD 和全因死亡率相关，但这种关联与肾功能无关。
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