Valvular calcification and left ventricular modifying in peritoneal dialysis patients

Figures & data

Table 1. Characteristics of study subjects.

	Value
Characteristic	Baseline	End of follow-up
Age (years) (median [IQR])	60.5 (19–76)
Gender (m/f) (n)	25 (50%)
Smokers (n)	18 (45%)	16 (32%)
Diabetes (n)	26 (52%)
BMI (kg/m^2)	25.9 ± 3.7	25.8 ± 2.6
SBP (mmHg; mean ± SD)	147.4 ± 20.1	134.2 ± 14.4^b
DBP (mmHg; mean ± SD)	89.2 ± 12.6	79.4 ± 9.8^a
Hemoglobin (g/dL; mean ± SD)	101.9 ± 10.3	109.8 ± 8.9
Serum albumin (g/L; mean ± SD)	30.9 ± 2.6	30.9 ± 2.6^b
Serum calcium (mmol/L; mean ± SD)	2.2 ± 0.2	2.2 ± 0.1
Phosphorous (mmol/L; mean ± SD)	1.8 ± 0.3	1.6 ± 0.2^b
Ca × P (mean ± SD)	3.9 ± 0.6	3.6 ± 0.6^b
iPTH (pg/mL; mean ± SD)	225.5 (97.8–387.0)	205.0 (102.0–336.0)
CRP (mg/L; mean ± SD)	11.1(6.1–16.4)	5.9(3.5–8.9)^a
Total cholesterol (mmol/L; mean ± SD)	6.5 ± 1.6	5.9 ± 1.2^b
Triglyceride (mmol/L; mean ± SD)	2.4 ± 1.3	2.0 ± 0.4
HDL (mmol/L; mean ± SD)	1.0 ± 0.3	1.3 ± 0.3^b
LDL (mmol/L; mean ± SD)	4.7 ± 1.4	3.8 ± 0.8^a
Homocysteine (µmol/L; median [IQR])	25.2 (20.2–30.1)	21.0 (16.7–23.4)^b
Nitric oxide (μmol/L; median [IQR])	40.72 (19.4–56.7)	45.95 (33.5–60.0)^a
Endothelin-1 (pg/ml; median [IQR])	4.0 (2.27–6.3)	4.68 (2.9–6.6)^a
Urine volume (mL/day; mean ± SD)	545.6 ± 378.5	538.0 ± 425.2
RRF (ml/min per 1.73 m^2; mean ± SD)	5.5 ± 3.8	6.5 ± 5.0^b
Total weekly Kt/V (mean ± SD)	1.9 ± 0.8	2.1 ± 0.9^b
Medication use
Erythropoietin (n; %)	36 (72)	43 (86)
Antihypertensive drugs (n; mean ± SD)	2.0 ± 1.0	1.5 ± 1.0
ACEI or ARB (n; %)	32 (64)	29 (58)
Vitamin D analogs (n; %)	19 (38)	22 (44)
Calcium-based phosphate binders (n; %)	40 (80)	37 (74)

Notes: IQR, interquartile range; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic BP; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker.

^aSignificant differences, p < 0.01.

^bSignificant differences, p < 0.05.

Table 2. Clinical and biochemical characteristics of all patients with and without left ventricular hypertrophy at baseline and 1 year later on PD.

	Baseline		End of follow-up
Characteristic	LVH (−) (11)	LVH (+) (39)	LVH (−) (16)	LVH (+) (34)
Age (years) (median [IQR])	46.5 (19–68)	57 (43–76)^a	44.3 (19–68)	60.5 (49–76)^b
Gender (m/f) (n)	7/4	17/22^a	10/7	14/20^b
Smokers (n)	1	14^a	0	13^b
Diabetes (n)	6	17^a	9	14^b
BMI (kg/m^2)	23.9 ± 3.4	26.5 ± 3.6	24.6 ± 2.2	26.4 ± 1.9
SBP (mmHg; mean ± SD)	128.2 ± 8.7	152.8 ± 19.1^a	123.6 ± 9.2^c	137.4 ± 14.6^b,c
DBP (mmHg; mean ± SD)	79.1 ± 9.4	92.1 ± 12.0^a	71.8 ± 24.1	82.1 ± 10.4^b,c
Hemoglobin (g/dL; mean ± SD)	108.8 ± 10.7	99.9 ± 9.4^a	111.0 ± 8.3^c	110.1 ± 9.1^c
Serum albumin (g/L; mean ± SD)	34.9 ± 4.3	29.5 ± 3.8	31.4 ± 2.1	30.9 ± 2.8
Serum calcium (mmol/L; mean ± SD)	2.3 ± 0.1	2.2 ± 0.2	2.2 ± 0.1	2.3 ± 0.1
Phosphorous (mmol/L; mean ± SD)	1.5 ± 0.2	1.8 ± 0.3^a	1.4 ± 0.2	1.7 ± 0.2^b,c
Ca × P (mean ± SD)	3.3 ± 0.6	4.0 ± 0.5^a	3.0 ± 0.4^c	3.8 ± 0.5^b
iPTH (pg/mL; mean ± SD)	173.6 ± 133.0	290.0 ± 210.3	136.6 ± 103.2	313.3 ± 246.8^b
CRP (mg/L; mean ± SD)	5.7 ± 3.5	13.9 ± 8.4^a	3.1 ± 1.5	9.0 ± 12.8^b,c
Total cholesterol (mmol/L; mean ± SD)	5.7 ± 1.9	6.7 ± 1.5^a	4.9 ± 1.0^c	6.0 ± 0.8^b,c
Triglyceride (mmol/L; mean ± SD)	2.0 ± 1.5	2.5 ± 1.2	1.4 ± 0.4^c	1.8 ± 0.3^bc
HDL (mmol/L; mean ± SD)	1.4 ± 0.3	1.0 ± 0.2^a	1.7 ± 0.2^c	1.2 ± 0.3^b
LDL (mmol/L; mean ± SD)	3.8 ± 1.9	5.0 ± 1.2^a	2.9 ± 0.5^c	4.0 ± 0.6^bc
Homocysteine (µmol/L; median [IQR])	20.2 (19.7–26.5)	26.6 (21.6–31.4)	14.8 (13.8–19.9)^c	22.2 (18.0–23.4)^b,c
Nitric oxide (μmol/L; median [IQR])	63.2 (59.7–106.2)	28.5 (14.8–46.8)^a	98.2 (63.9–106.2)^c	43.9 (33.0–49.1)^b,c
Endothelin-1 (pg/mL; median [IQR])	2.6 (2.2–4.0)	7.0 (4.1–8.8)^a	2.3 (2.0–2.9)^c	5.8 (4.0–8.0)^b,c
Urine volume (mL/day; mean ± SD)	750.0 ± 463.1	487.9 ± 335.9	959.1 ± 508.8	413.2 ± 320.4^b
RRF (mL/min per 1.73 m^2; mean ± SD)	7.2 ± 4.2	5.0 ± 3.5	10.7 ± 6.3^c	4.8 ± 3.7^b,c
Total weekly Kt/V (mean ± SD)	2.0 ± 0.9	1.77 ± 0.43	2.4 ± 0.7	2.1 ± 0.3^b
Medication use
Erythropoietin (n)	4	32	13	30
Antihypertensive drugs (n; mean ± SD)	1.5 ± 1.0	2 ± 1.0	1 ± 0.5	2 ± 1.0
ACEI or ARB (n)	2	30	4	25
Vitamin D analogs (n)	8	11	10	12
Calcium-based phosphate binders (n)	6	34	11	26

Notes: IQR, interquartile range; LVH, left ventricular hypertrophy; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic BP; iPTH, intact parathyroid hormone; CRP, C-reactive protein; HDL, high-density lipoprotein; LDL, low-density lipoprotein; RRF, residual renal function; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker

^aSignificant difference between without and with LVH at baseline.

^bSignificant difference between without and with LVH after 1 year.

^cSignificant difference in the same group before (basal) and 12 months after PD treatment.

Significant differences, p < 0.01; p < 0.05.

Table 3. Clinical and biochemical characteristics of all patients with and without valve calcification at baseline and 1 year later on PD.

	Baseline		12 months on PD
Variable	CVC (−) (21)	CVC (+) (29)	CVC (−) (24)	CVC (+) (26)
Age (years) (median [IQR])	42 ± 13	58 ± 18	40 ± 11	60 ± 16^b
Gender (m/f) (n)	15/6	10/19	16/8	9/17
Smokers (n)	8/12	18/12^a	8/15	18/9^b
Diabetes (n)	22.75 ± 2.9	27.56 ± 3.5^a	23.94 ± 1.6	26.98 ± 1.7 < 0.05^b,c
BMI (kg/m^2)	2/14	16/18^a	0/26	16/6^b
SBP (mmHg; mean ± SD)	137.50 ± 15.3	156.82 ± 19.6^a	123.68 ± 10.1^c	136.92 ± 10.3^b,c
DBP (mmHg; mean ± SD)	80.63 ± 11.2	95.91 ± 9.1^a	76.84 ± 7.5	80.0 ± 10.0^b
Hemoglobin (g/dL; mean ± SD)	109.1 ± 11.1	96.6 ± 7.8	125.1 ± 10.0^c	109.2 ± 9.6^b,c
Serum albumin (g/L; mean ± SD)	33.6 ± 4.1	28.2 ± 3.1^a	32.0 ± 2.1	30.5 ± 2.0^b
Serum calcium (mmol/L; mean ± SD)	2.2 ± 0.2	2.15 ± 0.2	2.26 ± 0.1	2.3 ± 0.1
Phosphorous (mmol/L; mean ± SD)	1.7 ± 0.3	1.9 ± 0.2^a	1.5 ± 0.2	1.8 ± 0.1^b,c
Ca × P (mean ± SD)	3.8 ± 0.7	3.98 ± 0.6	3.35 ± 0.5	3.96 ± 0.3^b,c
iPTH (pg/mL; mean ± SD)	224.0 ± 219.7	308.5 ± 208.7^a	241.4 ± 215.6	277.8 ± 156.2
CRP (mg/L; mean ± SD)	8.1 ± 5.8	16.1 ± 9.4^a	3.5 ± 2.7^c	6.8 ± 3.2^b,c
Total cholesterol (mmol/L; mean ± SD)	5.82 ± 1.1	7.10 ± 1.8	5.03 ± 1.3^c	6.28 ± 1.6^c
Triglyceride (mmol/L; mean ± SD)	2.07 ± 1.5	2.73 ± 1.2	1.83 ± 0.3	2.44 ± 4.0^b,c
HDL (mmol/L; mean ± SD)	1.23 ± 0.3	0.93 ± 0.2^a	1.56 ± 0.3^c	1.14 ± 0.3^b,c
LDL (mmol/L; mean ± SD)	3.78 ± 1.2	5.18 ± 1.5^a	3.31 ± 0.7^c	3.95 ± 0.7^b,c
Homocysteine (µmol/L; median [IQR])	22.9 (19.8–30.0)	28.0 (23.7–33.6)	16.8 (13.3–19.3)^c	20.9 (18.9–26.3)^b,c
Nitric oxide (μmol/L; median [IQR])	55.2 (45.7–69.4)	42.2 (34.9–56.8)^a	56.8 (46.6–72.4)	49.5 (33.0–66.2)^b,c
Endothelin-1 (pg/mL; median [IQR])	3.2(2.6–6.9)	4.1 (3.1–4.7)^a	3.0 (2.1–5.0)	3.4 (2.3–4.9)^c
Urine volume (mL/day; mean ± SD)	609.09 ± 311.3	424.00 ± 327.6^a	535.00 ± 396.7	226.15 ± 208.8^b,c
RRF (mL/min per 1.73 m^2; mean ± SD)	6.8 ± 4	3.9 ± 2^a	7.4 ± 2.7	3.7 ± 1.6^c
Total weekly Kt/V (mean ± SD)	2.0 ± 0.3	1.88 ± 0.76	2.2 ± 1.6	2.1 ± 0.2^c
LVH (%)	44	79	36	62
LVMi (g/m^2)	149.52 ± 34.9	176.58 ± 36.0^a	119.5 ± 29.6^c	173.75 ± 35.3^b,c
EF (%)	56.59 ± 7	44.32 ± 7.9^a	62.37 ± 8.2^c	48.38 ± 6.9^b,c
E/A ratio	1.04 ± 0.1	0.89 ± 0.1^a	1.14 ± 0.1	1.02 ± 0.0^b
Medication use
Erythropoietin (n)	14	22	18	25
Antihypertensive drugs (n; mean ± SD)	2.0 ± 0.5	1.5 ± 1.0	1.5 ± 1.0	2.5 ± 1.0
ACEI or ARB (n)	12	20	16	13
Vitamin D analogs (n)	11	8	14	8
Calcium-based phosphate binders (n)	13	27	11	26

Notes: IQR, interquartile range; CVC, cardiac valve calcification; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic BP; iPTH, intact parathyroid hormone; CRP, C-reactive protein; HDL, high-density lipoprotein; LDL, low-density lipoprotein; RRF, residual renal function; LVH, left ventricular hypertrophy; LVMi, LV mass index; EF, ejection fraction; E/A, the ratio of the early (E) to late (A) ventricular filling velocities; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker.

^aSignificant difference between non-CVC and with CVC at baseline.

^bSignificant difference between non-CVC and with CVC after 1 year.

^cSignificant difference in the same group before (basal) and 12 months after PD treatment.

Significant differences, p < 0.01; p < 0.05.

Table 4. Multiple logistic regression analysis for valvular calcification before and after one year on PD treatment.

Dependent variable	Predictors	B	SE	p	OR (95% CI)
Valvular calcification before RRT	Serum albumin	−1.111	0.459	0.015	0.329 (0.134 to 0.809)
	Hemoglobin	−0.155	0.074	0.037	0.857 (0.741 to 0.991)
	Endothelin-1	0.56	2.933	0.048	2.119 (1.927 to 2.408)
	LDL	1.402	0.652	0.032	4.063 (1.131 to 4.591)
	Age	0.171	0.078	0.029	1.186 (1.018 to 1.383)
Valvular calcification after  12 months on PD	Female	−3.137	1.546	0.042	0.043 (0.002 to 0.898)
	BMI	0.434	0.204	0.033	1.544 (1.035 to 2.304)
	CRP	0.453	0.171	0.008	1.572 (1.124 to 2.200)
	Nitric oxide	−0.622	0.048	0.031	0.902 (0.886 to 1.109)
	Hemoglobin	−0.310	0.093	0.001	0.733 (0.611 to 0.880)

Note: RRT, renal replacement therapy; SE, standard error; CI, confidence interval; OR, odds ratio; LDL, low-density lipoprotein; BMI, body-mass index; CRP, C-reactive protein.