Background
Methods
Design
Methods
Statistical analysis
Results
Demographics and baseline assessment
Patients (n) | 220 |
---|---|
Age (years) | 61.1 ± 6.1 |
Sex (male/female) | 154 (70%) / 66 (30%) |
Charlson Comorbidity Index | 5.76 ± 2.46 |
Body mass index (BMI) (Kg/m2) | 24.33 ± 4.39 |
Time on HD (months) (median) | 31 [9, 77.7] |
Previous kidney transplant | 51 (23.2%) |
Smoking (yes/no/former) | 35/130/55 (15.9%/59.1%/25%) |
Diabetes mellitus (yes/no) | 56 (25.5%)/164 (74.5%) |
Hypertension (yes/no) | 194 (88.2%)/26(11.8%) |
Dyslipidaemia (yes/no) | 84 (38.2%)/136 (61.8%) |
IMT, mean (mm) | 0.789 ± 0.282 |
IMT > 0.9 mm | 35 (15.9%) |
Presence of Plaques | 85 (84.2%) |
Calcified Plaques | 69 (68.4%) |
Presence of Stenosis | 40 (72.3%) |
LVH (%) | 54 (24.5%) |
LVMI (g/m2) | 96.27 ± 26.07 |
LV ejection fraction (%) | 58.34 ± 10.73 |
A) Mann-Whitney U-test | ||||
Osteoprotegerin | Fetuin-A | |||
Variable | Median (interquartile range) |
P-Value | Median (interquartile range) |
P-Value |
Previous Transplant | ||||
Yes | 9.77 (5.14–14.27) | 0.944 | 44.1 (30.18–58.51) |
0.022
|
No | 8.58 (6.21–12.69) | 35.24 (25.55–49.83) | ||
Diabetes Mellitus | ||||
Yes | 9.29 (7.06–11.76) | 0.575 | 31.12 (20.8–43.94) |
0.008
|
No | 8.63 (5.72–13.01) | 37.46 (28.04–54.02) | ||
Left Ventricular Hypertrophy | ||||
Yes | 10.02 (7.6–12.88) | 0.068 | 34.92 (26.13–51.19) | 0.639 |
No | 8.23 (5.65–12.99) | 37.02 (26.93–51.97) | ||
Arrhythmia | ||||
Yes | 12.1 (6.89–15.1) |
0.009
| 35.17 (26.79–55.41) | 0.916 |
No | 8.26 (5.91–11.85) | 37.02 (26.50–50.89) | ||
Statin treatment | ||||
Yes | 7.93 (6.1–10.62) | 0.086 | 35.17 (24.21–54.02) | 0.631 |
No | 9.67 (6.05–13.43) | 37.02 (26.87–50.75) | ||
ACEI/ ARB treatment | ||||
Yes | 7.84 (5.03–11.30) | 0.059 | 39.99 (33.68–57.52) | 0.078 |
No | 9.08 (6.38–13.04) | 35.17 (26.11–50.89) | ||
Beta-blockers treatment | ||||
Yes | 7.27 (4.99–11.49) |
0.038
| 37.03 (27.35–54.98) | 0.920 |
No | 9.08 (6.39–13.04) | 36.58 (26.50–50.92) | ||
Carotid Plaques | ||||
Yes | 8.5 (6.1–12.69) |
0.002
| 31.24 (23.48–44.91) | 0.728 |
No | 5.98 (3.41–7.77) | 35.34 (22.37–51.71) | ||
Calcified Plaques | ||||
Yes | 8.22 (6.23–12.66) |
0.038
| 30.14 (23.49–44.34) | 0.378 |
No | 6.94 (4.97–10.64) | 37.04 (21.54–51.46) | ||
Severe Degrees of CAD | ||||
Yes | 8.5 (6.1–12.69) |
0.002
| 31.24 (23.48–44.91) | 0.728 |
No | 5.98 (3.41–7.77) | 35.34 (22.37–51.71) | ||
B) Spearman rank correlation test | ||||
Osteoprotegerin | Fetuin-A | |||
Variable | Rho Spearman |
P-Value | Rho Spearman |
P-Value |
Age (years) | 0.383 |
< 0.001
| −0.161 |
0.018
|
LV mass (gr) | 0.126 | 0.117 | −0.19 |
0.020
|
LV ejection Fraction (%) | −0.206 |
0.01
| −0.056 | 0.491 |
Charlson Comorbility Index | 0.38 |
< 0.001
| −0.14 |
0.040
|
Calcium (mg/dl) | 0.115 | 0.088 | −0.015 | 0.828 |
Phosphate (mg/dl) | −0.245 |
< 0.001
| 0.011 | 0.870 |
iPTH (pg/ml) | −0.118 | 0.083 | −0.083 | 0.228 |
Ca-P product | −0.2 |
0.003
| 0.012 | 0.861 |
Dose of calcium salts (gr/day) | −0.016 | 0.816 | 0.207 |
0.003
|
Creatinine (mg/dl) | −0.224 |
0.001
| 0.096 | 0.161 |
BUN (mg/dl) | −0.156 |
0.039
| 0.017 | 0.824 |
Troponin I (ng/ml) | 0.207 |
0.003
| −0.071 | 0.312 |
BNP (pg/ml) | 0.305 |
< 0.001
| −0.091 | 0.182 |
Systolic Blood Pressure (mmHg) | −0.008 | 0.907 | −0.017 | 0.805 |
Diastolic Blood Pressure (mmHg) | −0.081 | 0.243 | −0.028 | 0.690 |
Mean Blood Pressure (mmHg) | −0.049 | 0.479 | −0.025 | 0.727 |
Adiponectin (μg/ml) | 0.237 |
< 0.001
| −0.04 | 0.558 |
IL-6 (pg/ml) | 0.075 | 0.291 | −0.16 |
0.027
|
CRP (mg/dl) | 0.062 | 0.362 | −0.013 | 0.846 |
Malondialdehyde (mMol/L) | 0.086 | 0.205 | 0.179 |
0.009
|
Homocysteine (μmol/L) | −0.021 | 0.757 | −0.137 |
0.047
|
ADMA (μmol/L) | −0.034 | 0.625 | 0.143 |
0.040
|
Carotid Intima-media thickness (mm) | 0.234 |
0.034
| −0.071 | 0.529 |
Prospective study
Cox regression analysis
Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|
Variable | HR (CI 95%) |
P-Value | HR (CI 95%) |
P-Value |
Age (years) | 1.052 (1.032–1.072) |
<0.001
| 1.031 (1.002–1.06) |
0.036
|
Charlson Comorbidity Index | 1.305 (1.194–1.427) |
<0.001
| 1.254 (1.075–1.462) |
0.004
|
Previous cardiovascular disease (yes/no) | 2.185 (1.30–3.65) |
0.003
| - | |
Incident cardiovascular disease (yes/no) | 2.654 (1.646–4.279) |
<0.001
| - | |
Left Ventricular Hypertrophy (yes/no) | 1.764 (1.093–2.845) |
0.002
| - | |
Previous Kidney Transplant (yes/no) | 0.374 (0.186–0.751) |
0.006
| - | |
Interdialytic weight gain (kg) | 0.764 (0.579–1.007) | 0.056 | - | |
Dyslipidaemia (yes/no) | 1.255 (0.793–1.985) | 0.332 | - | |
Diabetes Mellitus (yes/no) | 1.401 (0.861–2.28) | 0.174 | - | |
Hypertension (yes/no) | 1.32 (0.606–2.878) | 0.485 | - | |
Smoking (yes/no) | 2.185 (1.376–3.47) |
0.001
| 2.122 (1.251–3.599) |
0.005
|
Systolic Blood Pressure (mmHg) | 0.993 (0.983–1.004) | 0.191 | - | |
Diastolic Blood Pressure (mmHg) | 0.975 (0.957–0.994) |
0.010
| - | |
Mean Blood Pressure (mmHg) | 0.983 (0.968–0.999) |
0.032
| - | |
Statin treatment (yes/no) | 1.516 (0.929–2.473) | 0.096 | - | |
Osteoprotegerin (highesttertile) | 1.9 (1.203–2.999) |
0.006
| 1.957 (1.123–3.411) |
0.018
|
Calcium (mg/dl) | 1.136 (0.9–1.434) | 0.284 | - | |
Phosphate (mg/dl) | 0.868 (0.745–1.013) | 0.072 | - | |
iPTH (pg/ml) | 0.999 (0.998–1.000) | 0.114 | - | |
Fetuin-A (ng/ml) | 0.994 (0.984–1.004) | 0.230 | - | |
Albumin (g/l) | 0.884 (0.844–0.925) |
<0.001
| 0.886 (0.837–0.937) |
< 0.001
|
C-reactive protein (mg/dl) | 1.17 (1.09–1.252) |
<0.001
| - | |
Adiponectin (μg/ml) | 1.003 (0.973–1.033) | 0.867 | - | |
IL-18 (pg/ml) | 1.0 (1.00–1.001) |
0.011
| 1.061 (1.036–1.087) |
<0.001
|
Troponin I (ng/ml) | 12.626 (3.795–42.01) |
<0.001
| 3.894 (1.048–14.462) |
0.042
|
BNP (pg/ml) | 1.0 (1.0–1.001) |
0.001
| - | |
LV ejection fraction (%) | 0.966 (0.945–0.987) |
0.002
| - |
Multivariate analysis
Variable | β (CI 95%) |
P-Value |
---|---|---|
Multiple regression analysis OPG
| ||
Age (years) | 0.113 (0.074–0.152) |
<0.001
|
BNP (100 pg/ml) | 0.202 (0.103–0.301) |
<0.001
|
Adiponectin (μg/ml) | 0.126 (0.042–0.210) |
0.003
|
Statin Treatment (yes) | −1.977 (−3.386- -0.568) |
0.006
|
Multiple regression analysis Fetuin-A
| ||
Age (years) | −0.074 (−0.649–256) | 0.392 |
Dose of calcium salts (gr/day) | 0.063 (−0.003–0.007) | 0.461 |
Malondialdehyde (mmol/L) | 0.322 (0.211–0.699) |
<0.001
|
IL-6 (pg/ml) | −0.154 (−0.118–0.007) | 0.079 |