The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study

Abstract

Objectives: This study aimed to find out the relationship between vascular calcification, arterial stiffness, and nutritional status, and investigate their effects on 5-year mortality. Materials and Methods: This study included 79 hemodialysis patients. Fetuin-A and FGF-23 levels were measured. The average blood pressure (BP) of the previous 12 months was used. The abdominal aortic calcification (AAC) score was measured from lateral abdominal radiographs. Carotidfemoral pulse wave velocity (cf-PWV) was used for arterial stiffness assessment. The geriatric nutritional risk index (GNRI) was used for nutritional status, and calculated as the following formula; [14.89*serum albumin (g/dL)] + (41.7* body weight/ideal body weight). Results: Twenty-five (31.6%) of 79 patients died within 5 years. When the alive and deceased groups were compared age (p=0.001), diabetes mellitus (p=0.041), GNRI (p=0.019), AAC score (p=0.009), cf-PWV (p=0.003), albumin (p=0.030), C-reactive protein (p=0.003), mean systolic BP before dialysis (p=0.018), and mean diastolic BP before dialysis (p=0.045) were significantly different between two groups, whereas Fetuin-A and FGF-23 were not. AAC score above 3 points [area under the curve (AUC): 0.682], cf-PWV above 8.1 (AUC: 0.727), and GNRI score 99.2 and lower (AUC: 0.663) had estimated 5-year mortality well. GNRI was the only independent variable (hazard ratio: 0.924, p=0.047) in multivariable cox regression analysis. Conclusion: There was a close relationship between AAC score, GNRI, cf-PWV, and long-term mortality. The cf-PWV and its close relationship with average BP measurements must be assessed for future studies. Following GNRI must be targeted for its crucial role as an independent factor of mortality. Key Words: Vascular Calcification, Arterial Stiffness, Nutrition, FGF-23, Fetuin-A

Keywords

• Vascular Calcification
• Arterial Stiffness
• Nutrition
• FGF-23
• Fetuin-A

Hemodiyaliz Hastalarında Vasküler Kalsifikasyon, Arteriyel Sertlik ve Nütrisyonel Durumun Değerlendirilmesi, 5 Yıllık Takip Çalışması

Abstract

Amaç: Bu çalışmada vasküler kalsifikasyon, arter sertlik ve nütrisyonel durum arasındaki ilişkinin ortaya çıkarılması ve 5 yıllık mortalite üzerine etkilerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya 79 hemodiyaliz hastası dahil edildi. Fetuin-A ve FGF-23 kan seviyeleri ölçüldü. Önceki 12 ayın ortalama kan basıncı (KB) değerleri kullanıldı. Abdominal aortik kalsifikasyon (AAK) skoru lateral abdominal grafilerden ölçüldü. Arteriyel sertliğin değerlendirmesinde karotis-femoral nabız dalga hızı (kf-NDH) kullanıldı. Nütrsiyonel durumun değerlendirilmesi için geriatrik nütrisyonel risk indeksi (GNRI) kullanıldı. GNRI formülü; [14,89*serum albümini (g/dL)] + (41,7* vücut ağırlığı/ideal vücut ağırlığı). Bulgular: Yetmiş dokuz hastanın 25’i (%31,6) 5 yıl içinde öldü. Sağkalan ve ölen gruplar karşılaştırıldığında yaş (p=0,001), diabetes mellitus (p=0,041), GNRI (p=0,019), AAK skoru (p=0,009), kf-NDH (p=0,003), albümin (p=0,030), C-reaktif protein (p=0,003), diyaliz öncesi ortalama sistolik KB (p=0,018) ve diyaliz öncesi ortalama diyastolik KB (p=0,045) açısından iki grup arasında anlamlı fark bulunurken, Fetuin-A ve FGF-23 açısından fark bulunmadı. AAK skoru >3 [eğri altında kalan alan (AUC): 0,682], kf-NDH >8,1 (AUC: 0,727) ve GNRI ≤99,2 (AUC: 0,663) 5 yıllık mortaliteyi öngeren değerler olarak bulundu. Çok değişkenli Cox regresyon analizinde GNRI tek bağımsız değişkendi (tehlike oranı: 0,924, p=0,047). Sonuç: AAK skoru, GNRI, kf-NDH ve uzun dönem mortalite arasında yakın ilişki mevcuttur. Kf-NDH ve ortalama KB ölçümleri ile yakın ilişkisi gelecekteki çalışmalar için değerlendirilmelidir. Bağımsız bir mortalite faktörü olarak kritik rolü nedeniyle GNRI skorlarının takibi hedeflenmelidir. Anahtar Kelimeler: Vasküler Kalsifikasyon, Arteriyel Sertlik, Beslenme, FGF-23, Fetuin-A

Keywords

• Vasküler Kalsifikasyon
• Arteriyel Sertlik
• Beslenme
• FGF-23
• Fetuin-A

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