关键词: 糖尿病肾病, 慢性肾脏病-矿物质和骨异常, 心血管钙化

Abstract:

ABSTRACT
Objective: To evaluate the distribution of cardiovascular calcification and its risk factors in diabetic nephropathy patients with renal dysfunction. Methodology: Two hundred seventy diabetic nephropathy patients with renal dysfunction {chronic kidney disease (CKD) stages 2-5 and non-dialysis} were enrolled into this cross-sectional study. Coronary calcification score was detected by spiral computed tomography, abdominal aortic calcification score was detected by abdominal lateral radiographs, and the valve calcification was examined by cardiac ultrasound. Information about mineral disorder was collected. The related risk factors for cardiovascular calcification were evaluated by Logistic regression. Results: There were 40 patients in CKD stage 2, 121 in stage 3 , 63 in stage 4 and 46 in stage 5 . With the progression of CKD stages, the level of serum phosphorus was increased and serum calcium was decreased gradually, while the level of intact parathyroid hormone was increased and 25-Hydroxyvitamin D was decreased (P<0.01). The total calcification prevalence was 70.3% in these patients, and the prevalence of coronary calcification, abdominal aortic calcification and valve calcification was 55.1%, 43.4% and 23.9%, respectively. The total calcification prevalence in CKD stages 2-5 was 72.5%, 73.6%, 66.7% and 63.0%, respectively. The incidence of cardiovascular calcification was associated with the age, duration of diabetes, duration of hypertension, history of cardiovascular diseases and the present of carotid artery plaque. No significant correlations were observed between calcification and sex, dyslipidemia, serum phosphorus and calcium, intact parathyroid hormone or stages of CKD. Among those, age, history of cardiovascular diseases and the present of carotid artery plaque were independent risk factors for coronary and abdominal aortic calcification, while the age was the only independent risk factor for the valve calcification. Conclusion: The prevalence of cardiovascular calcification was high in diabetic nephropathy patients with renal dysfunction, even in early stage of CKD (stage 2) when mineral disorder was not obvious. The incidence of cardiovascular calcification was associated with traditional cardiovascular risk factors but not mineral disorder or stages of CKD.

Key words: diabetic nephropathy, chronic kidney disease-mineral and bone disorder,, cardiovascular calcification