Association between vascular calcification, atherosclerosis and inflammatory markers in end-stage renal disease patient and simple method for detecting vascular calcification (direct radiography)

Öz

Purpose: In our study, we planned to investigate the relationship of malnutrition with inflammation, atherosclerosis and calcification in dialysis patients. Materials and methods: 140 Chronic kidney disease (CKD) patients and 44 healthy controls were included in the study. Carotid artery intima-media thickness (CIMT) was measured by doppler ultrasonography. Valvular calcification was assessed by echocardiography and vascular calcification scores (VCS) were done based on the radiograms. Biochemical parameters were assessed using routine laboratory methods. Subjective global assessment (SGA) was used to evaluate malnutrition. Results: In the study, VCS showed no differences between hemodialysis (HD) and peritoneal dialysis (PD) patients (1.84±2.35 for HD, 1.77±1.64 for PD; p=0.83). CIMT, Osteopontin (OPN), interleukin-6 (IL-6) and homocysteine were significantly different in both dialysis groups compared to healthy controls. The Mean carotid intima-media thickness (m-CIMT) was higher in HD patients compared to PD group. CIMT, vascular calcification and SGA scores showed positive correlation with age, dialysis duration and valvular calcification grades, and negative correlation with albumin levels. A positive correlation between SGA scores and high-sensitive C-reactive protein (hs-CRP) levels was also noted. On multiple regression analysis, m-CIMT was independently associated with age, VCS and albumin levels. VCS was found to be independently associated with only albumin levels. Conclusion: Vascular and valvular calcification, an indicator of cardiovascular mortality and morbidity in dialysis patients, was found to be significantly associated with malnutrition. We found higher rates of valvular calcification in patients with vascular calcification. Malnutrition was more prominent in these patients.

Anahtar Kelimeler

• Atherosclerosis
• calcification
• chronic renal failure
• inflammation
• malnutrition

Son dönem böbrek yetmezlikli hastalarda vasküler kalsifikasyon, ateroskleroz ve inflamatuar belirteçler arasındaki ilişki ve vasküler kalsifikasyonun saptanmasında basit bir yöntem (direkt radyografi)

Öz

Amaç: Çalışmamızda diyaliz hastalarında malnütrisyonun; inflamasyon, ateroskleroz ve kalsifikasyonla olan ilişkisini araştırmayı planladık. Gereç ve yöntem: Çalışmaya 140 kronik böbrek yetmezlikli (KBH) hasta ve 44 sağlıklı kontrol dahil edildi. Karotis intima-media kalınlığı (KİMK) doppler ultrasonografi ile ölçüldü. Kapak kalsifikasyonu ekokardiyografi ile değerlendirildi ve direkt grafi ile vasküler kalsifikasyon skorları (VKS) hesaplandı. Biyokimyasal parametreler rutin laboratuvar yöntemleri kullanılarak değerlendirildi. Malnütrisyonun değerlendirilmesinde subjektif global değerlendirme skorlaması (SGA) kullanıldı. Bulgular: Çalışmada hemodiyaliz (HD) ve periton diyalizi (PD) hastaları arasında VKS açısından fark bulunmadı (HD için 1,84±2,35, PD için 1,77±1,64; p=0,83). KİMK, Osteopontin (OPN), interlökin-6 (IL-6) ve homosistein her iki diyaliz grubunda sağlıklı kontrollerle karşılaştırıldığında anlamlı olarak farklıydı. Ortalama karotis intima media kalınlığı (m-KİMK) HD hastalarında PD grubuna göre daha yüksekti. KİMK, vasküler kalsifikasyon ve SGA skorları yaş, diyaliz süresi ve kapak kalsifikasyon dereceleri ile pozitif, albümin seviyesi ile negatif korelasyon göstermekteydi. SGA skorları ile yüksek duyarlı C-reaktif protein (hs-CRP) seviyeleri arasında da pozitif yönde korelasyon kaydedildi. Çoklu regresyon analizinde m-KİMK bağımsız olarak yaş, VCS ve albümin seviyesi ile ilişkili bulunurken; VCS'nun bağımsız olarak sadece albümin seviyesi ile ilişkili olduğu bulundu. Sonuç: Çalışmamızda diyaliz hastalarında kardiyovasküler mortalite ve morbiditenin önemli bir göstergesi olan vasküler-valvüler kalsifikasyonla malnütrisyonun önemli ilişkisinin olduğunu gördük. Vasküler kalsifikasyonu olan hastalarda valvüler kalsifikasyon belirgindi. Bu grup hastada malnütrisyon da belirgindi.

Anahtar Kelimeler

• Ateroskleroz
• kalsifikasyon
• kronik böbrek yetmezliği
• inflamasyon
• malnütrisyon

Kaynakça

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