Supervisors info:
Τούσουλης Δημήτριος, Καθηγητής, Ιατρική, ΕΚΠΑ
Κυρίτση Ελένη, Ομότιμη Καθηγήτρια, Νοσηλευτική, Πανεπιστήμιο Δυτικής Αττικής
Τούτουζας Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Introduction: Vascular calcification is considered one of the most important risk factors for increased cardiovascular morbidity and mortality in patients with Chronic Kidney Disease. Vascular calcification as a general phenomenon, as well as the calcification of coronary vessels, is observed in almost all people over 65 years old.
Purpose: The purpose of this study is to investigate the incidence of vascular calcification and cardiovascular risk of hemodialysis patients.
Material and Method: The study method sample consisted of 87 hemodialysis patients enrolled for hemodialysis in Bioclinic Department of Artificial Kidney of Athens. The data were collected from patients’ files and from laboratory and imaging tests. All statistical analyzes were performed with the SPSS version 22 statistical package and statistical tests were performed t-test, anova and x2-test. The significance level 5% was considered as statistically significant.
Results: 65,5% of the patients in the sample were male. Smokers were 35,6%and 13,8% of them smoke more than 1 packet per day. The starting age of hemodialysis at 31% in the sample was under the age of 50 and at 71% in the sample the time period of hemodialysis was over 4 years.94,3% of the sample had concomitant diseases. Concerning the ultrasonography heart finds, 36,8% had left ventricular dilatation, 72,4% had left atrium dilatation, 5,7% had right ventricular dilatation and 4,6% had right atrium dilatation. 14,8% of the sample had extrusion fraction below 40%, 53,9% of the sample had 45-55% and 31% of the sample had over 56%. 36,8% of the sample had low degree of calcification in one of the cardiac valves, 27,6% moderate and 6,9 high. 47,1% had mitral calcification, 50,6% aortic calcification, 5,7% tricuspid calcification and 1,1% pulmonary calcification. 36,8% had a narrowing of the arterial trunk by less than 30%, 19,5% had stenosis of 31-50%, 9,2% had stenosis of 51-70%, and 19,5% had stenosis over 70%. Also, along the arterial trunk, 92% exhibits atherosclerosis lesions while 23% of the sample exhibits inferior vein deficiency. Mitral valve calcification occurs more frequently to those with lower hematocrit values, p=0,014 and to those with higher glucose values, p=0,013. Aortic valve calcification occurs more frequently to those with an average age of 69 years old, p=0,052 and to those with higher urea values, p=0,006. Those suffering from type II diabetes and diabetic retinopathy, appear to have more frequently mitral and aortic valve calcification, p=0,012 and p=0,033. Respectively, patients undergoing to hemodialysis for more than 7 years had more frequently aortic valve calcification, p=0,034. Patients with vasculopathy have a moderate and high degree of calcification, p<0,001, as well as aortic valve calcification, p=0,016. Those taking medication for dyslipidemia appear to have more frequently moderate and high degree of calcification, p=0,020, but also mitral valve calcification, p=0,013.
Conclusion: in chronic hemodialysis patients, the factors responsible for vascular calcification are hemodialysis time, age and concomitant illness.
