الفهرس 
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Abstract
Summary
Chronic kidney disease (CKD) and renal function decline increase cardiovascular mortality. Dialysis patients die most from it, and most start renal replacement treatment with abnormal cardiovascular function and size. Uremia, disordered mineral-bone disease, premature cardiovascular tissue damage, inflammatory and oxidative stresses, and others may explain these findings, as traditional risk factors like hypercholesterolemia and arterial hypertension cannot.
We’ll discuss the newest findings on cardiovascular calcifications in CKD, which grow common as the disease develops and predict cardiovascular morbidity and death.
Cardiovascular calcification in CKD may be a result of vascular inflammation and not a therapy target.
Inflammation is not a key component of vascular media degenerative calcification. Measures that experimentally minimise CKD-associated vascular calcification without affecting inflammation improve survival.
We recognise that there is a lack of evidence to substantiate this in CKD patients, and treatment methods that alter calcification in patients frequently have several effects. Thus, patients may not be able to answer this question.
Cardiac valve calcification (CVC) contributes to heart structural alterations and CVD in dialysis patients. CVC is rising because to dialysis vintage, calcium and phosphorus problems, and long-term usage of binders. KDIGO recommendations propose monitoring CVC risk with cardiac Doppler echocardiography in CKD 3–5 patients.
Increased B-mode ultrasonography carotid intimal media thickness (CIMT) indicates generalised atherosclerosis. CIMT > 0.75 mm was related with cardiovascular mortality, and CIMT at baseline was connected with CVD and death in PD patients.
Adults’ normal CIMT readings for the common carotid artery or all segments range from 0.4 to 1 mm, with a yearly progression of 0.01 to 0.02 mm. A CIMT result exceeding 1 mm thickness was abnormal.
The main aim of this study was to study the Correlation of mitral and aortic annular calcifications with carotid intima media thickness as a marker of extensive atherosclerosis in non-diabetic chronic kidney disease patients.
This Prospective Case control studywas conducted at Internal medicine and cardiology department at Beni-Suef university hospital from December, 2021 to May, 2022. This study included 150 patients selected from the outpatient clinic in Beni-Suef University Hospital. In addition to 50 healthy patients of matched age and sex chosen as control group.
They were divided into the following groups:
• group 1: 50 patients are CKD stage 3.
• group 2: 50 patients are CKD stage 4.
• group 3: 50 patients are CKD stage 5 (on hemodialysis).
• group 4: 50 healthy persons.
The main results of the study revealed that:
There was a statistical significant difference with p-value <0.001 between study groups as regards age, height, weight and BMI. Older ages were in group 3, lower mean of height and weight were in group 2. In addition there was a statistical significant higher level of systolic and diastolic blood pressure among group 3. There was a statistical significant higher percentage of male were in group 3 and higher percentage of females was in group 1. On the other hands no significant difference between groups as regards BMI.
There was a statistical significant lower mean of HB, calcium, HDL and a higher mean of phosphate, LDL, TG, and cholesterol level in group 2. In addition higher level of creatinine, Urea, PTH, and lower level of GFR, and calcium noticed in group 3. The lower level of PLT was in group 1 with p-value <0.05. On the other hands there was no statistical significant difference with p-value >0.05 as regards TLC level.
There was a statistical significant difference with p-value <0.001 between study groups as regards CIMT. Higher thickness was noticed in group 2 and 3.
There was a statistical significant difference with p-value <0.001 between study groups as regards valveular calcification prevalence. Higher percentage of cases with valvular calcification noticed among group 2.
There was a statistical significant difference with p-value <0.001 between study groups as regards grade of mitral valve calcification. Higher percentage of grade 1 valvular calcification noticed among group 3, and grade 2 and 3 valvular calcification noticed among group 2.
There was a statistical significant difference with p-value <0.001 between study groups as regards grade of aortic valve calcification. Higher percentage of grade 1 of valvular calcification noticed among group 1, and higher percentage of grade 2 in group 3.
There was a statistical significant difference with p-value 0.001 between study groups as regards mitral regurge prevalence. Higher percentage of MR noticed among group 3.
there was a statistical significant difference with p-value <0.05 between different calcification groups as regards sex distribution and MR with higher percentage of valvular calcification noticed among cases with MR, and males 37.7% versus 19.5% with no valvular calcification.
There was a statistical significant higher mean of systolic and diastolic blood pressure among cases with valvular calcification with p-value <0.05.
There was a statistical significant higher mean of urea and creatinine level and a lower mean of GFR among cases with valvular calcification with p-value <0.001.
There was a statistical significant higher mean of phosphorus and PTH level and a lower mean of calcium among cases with valvular calcification with p-value <0.001.
There was a statistical significant higher mean of triglyceride, cholesterol, and carotid intra median thickness among cases with valvular calcification with p-value <0.001.
There was a statistical significant positive correlation with p-value <0.05 between GFR level and each of hemoglobin, PLT, calcium, and HDL levels. In addition there was a statistical significant negative correlation with p-value <0.05 between GFR level and each of age, SBP, DBP, creatinine, urea, phosphorus, PTH, LDL, TG, cholesterol, and CIMT. On the other hand, there was no statistical significant correlation with p-value >0.05 between GFR level and BMI, and TLC levels.
There was a statistical significant positive correlation with p-value <0.05 between GFR level and each of age, BMI, creatinine, urea, PTH, LDL, TG, and cholesterol. In addition there was a statistical significant negative correlation with p-value <0.05 between GFR level and each of calcium, and HDL levels. On the other hand, there was no statistical significant correlation with p-value >0.05 between CIMT level and each of SBP, DBP, hemoglobin, TLC, PLT and phosphorus levels.
There was a statistical significant negative correlation with p-value <0.001 between calcification grades of both mitral and aortic valves and GFR level but a positive correlation with CIMT level.
Sensitivity and specificity test of GFR level illustrated a sensitivity of (83.6%) and a specificity of (50%) at cut off value (53.6).
The multivariate linear regression model analysis was conducted to explore the explanatory power of different investigations and risk factors in prediction of CIMT. It illustrated that there was statistical significance predictor effect with p-value <0.05 to age, BMI, PLT, GFR, phosphorus, LDL, and cholesterol levels.