不同透析模式对患者血清非磷酸化-未羧化的基质gla蛋白水平和血脂分布的影响及与血管钙化的相关性

doi:10.3969/j.issn.1006-5725.2025.22.014

Abstract

Abstract:

Objective To investigate the effects of different dialysis modalities on serum levels of dephosphorylated-uncarboxylated matrix Gla protein （dp-ucMGP）， lipid profiles， and vascular calcification in maintenance hemodialysis （MHD） patients， and to identify the risk factors associated with vascular calcification in this population. Methods A total of 87 MHD patients admitted to the hospital between January 2019 and December 2022 were enrolled as study participants. Based on their dialysis modalities， they were categorized into three groups： the hemodialysis （HD） group， the HD combined with hemodiafiltration （HD + HDF） group， and the HD， HDF combined with hemoperfusion （HD + HDF + HP） group， with 29 patients in each group. The serum dp-ucMGP levels， lipid profiles， and extent of vascular calcification were compared across the three groups. Patients were divided into a vascular calcification group and a non-vascular calcification group based on the presence or absence of vascular calcification. Univariate analyses and multivariate analysis were performed to identify factors potentially associated with vascular calcification in patients undergoing MHD. Results The results demonstrated that the levels of blood phosphorus， intact parathyroid hormone （iPTH）， serum dp-ucMGP， total cholesterol （TC）， triglycerides （TG）， and low-density lipoprotein cholesterol （LDL-C） were significantly higher in the HD group compared to the HD + HDF and HD + HDF + HP groups. Conversely， high-density lipoprotein cholesterol （HDL-C） levels were significantly lower in the HD group than in the other two groups， and all differences were statistically significant （P < 0.05）. The levels of blood phosphorus， iPTH， and serum dp-ucMGP in the HD + HDF group were significantly higher than those in the HD + HDF + HP group， with statistically significant differences （P < 0.05）. Compared with the HD group， the vascular calcification rate in the HD + HDF + HP group was significantly lower （P < 0.05）. In comparison to the non-vascular calcification group， the vascular calcification group exhibited significant increases in MHD dialysis duration， age， pulse pressure， blood phosphorus， blood calcium， iPTH， LDL-C， TC， and dp-ucMGP （P < 0.05）. Binary logistic regression analysis revealed that dialysis vintage， age， serum phosphorus， calcium， iPTH， and serum dp-ucMGP levels were independently associated with a higher risk of vascular calcification in MHD patients （P < 0.05）. Conclusions Compared with the simple HD or HD + HDF dialysis modalities， the HD + HDF + HP regimen is associated with lower levels of serum phosphorus， iPTH， dp-ucMGP， lipids， and vascular calcification prevalence in MHD patients. However， dialysis modality itself was not an independent predictor of vascular calcification. Instead， factors such as dialysis vintage， age， serum phosphorus， calcium， iPTH， and dp-ucMGP were independently associated with vascular calcification in this population.

Key words: maintenance hemodialysis, dialysis mode, non-phosphorylated-uncarboxylated matrix gla protein, blood lipid, vascular calcification

CLC Number:

R459.5

Tingting SUN,Mingai SONG,Jianfeng LI. Study on the effects of different dialysis modes on serum dp⁃ucMGP levels and lipid distribution in patients and their correlation with vascular calcification[J]. The Journal of Practical Medicine, 2025, 41(22): 3566-3571.

Figures/Tables 3

Tab.1

Tab.2

Tab.3

References 25

[1]	PATEL N， YAQOOB M M， AKSENTIJEVIC D， et al. Cardiac metabolic remodelling in chronic kidney disease［J］. Nat Rev Nephrol， 2022， 18（8）： 524-537. doi:10.1038/s41581-022-00576-x doi: 10.1038/s41581-022-00576-x
[2]	陈如萍，刘蕊，孙遨，等. 基于社区老年健康体检人群的慢性肾脏病流行病学调查［J］. 实用医学杂志， 2021， 37（13）： 1755-1760.
[3]	CUI X， JIANG S， LIU L， et al. Effect of low-dose lanthanum carbonate on calcium and phosphorus metabolism in Asian Patients with end-stage renal disease， maintenance hemodialysis and hyperphosphatemia［J］. Afr Health Sci， 2022，22（2）： 362-368. doi:10.4314/ahs.v22i2.41 doi: 10.4314/ahs.v22i2.41
[4]	KERYAKOS H K H， OKAILY N I， BOULIS M A Y， et al. Osteocalcin and vascular calcification in hemodialysis patients： An observational cohort study［J］. Int Urol Nephrol， 2021， 53（5）： 1015-1023. doi:10.1007/s11255-020-02753-y doi: 10.1007/s11255-020-02753-y
[5]	KHAMIS S S A， TAWFEEK A R， AL-HELBAWY M G A D， et al. Predictors of vascular calcification in hemodialysis patients［J］. Open J Nephrol， 2021， 11（2）： 273-280. doi:10.4236/ojneph.2021.112022 doi: 10.4236/ojneph.2021.112022
[6]	MAO L， HUANG H， ZHOU M， et al. Correlation between circulating dephosphorylated uncarboxylated matrix Gla protein and vascular calcification in peritoneal dialysis patients［J］. Int J Artif Organs， 2024， 47（12）：885-893. doi:10.1177/03913988241293980 doi: 10.1177/03913988241293980
[7]	DAI N， DIAO Z， HUANG H， et al. Disturbed carnitine metabolism is independently correlated with sarcopenia and prognosis in patients on hemodialysis［J］. Clin Nutr， 2024， 43（9）： 2019-2027. doi:10.1016/j.clnu.2024.07.019 doi: 10.1016/j.clnu.2024.07.019
[8]	AHLMANN C， STRONACH L， WATERS K， et al. Hemodiafiltration for children with stage 5 chronic kidney disease： Technical aspects and outcomes［J］. Pediatr Nephrol， 2024， 39（9）：2611-2626. doi:10.1007/s00467-024-06285-w doi: 10.1007/s00467-024-06285-w
[9]	ROSE M， FISCHER F， HOCKHAM C， et al. The CONVINCE randomized trial found positive effects on quality of life for patients with chronic kidney disease treated with hemodiafiltration［J］. Kidney Int， 2024， 106（5）： 961-971. doi:10.1016/j.kint.2024.07.014 doi: 10.1016/j.kint.2024.07.014
[10]	YAO Z， WANG P， FU Q， et al. Efficacy and safety of plasma exchange combined with hemoperfusion in the treatment of organophosphorus poisoning： A meta-analysis［J］. Blood Purif， 2023， 52（6）： 578-590. doi:10.1159/000530117 doi: 10.1159/000530117
[11]	HUU D N， QUY Q D B， THU H N T， et al. A combination of hemodialysis with hemoperfusion helped to reduce the cardiovascular-related mortality rate after a 3-year follow-up： A pilot study in vietnam［J］. Blood Purif， 2021， 50（1）：65-72. doi:10.1159/000507912 doi: 10.1159/000507912
[12]	MADUELL F， BROSETA J J. Hemodiafiltration （HDF） versus expanded hemodialysis （HDx）［J］. Semin Dial， 2022， 35（5）： 436-439. doi:10.1111/sdi.13071 doi: 10.1111/sdi.13071
[13]	WANG J， LUO Y， JI X， et al. Effects of different hemodialysis modalities combined with low-calcium dialysate on mineral metabolism and vascular calcification in maintenance hemodialysis patients with chronic kidney disease［J］. J Appl Biomed， 2024， 22（4）：228-233. doi:10.32725/jab.2024.027 doi: 10.32725/jab.2024.027
[14]	LI N， CUI W， MU D， et al. Effects of roxadustat on thyroid hormone levels and blood lipid metabolism in patients undergoing hemodialysis： A retrospective study［J］. Int J Med Sci， 2024， 21（10）： 1806-1813. doi:10.7150/ijms.97599 doi: 10.7150/ijms.97599
[15]	SAITO T， MIZOBUCHI M， HAMADA T， et al. Tumoral calcinosis due to severe hyperphosphatemia and secondary hyperparathyroidism without vascular calcification in a hemodialysis patient［J］. Clin Nephrol， 2021， 95（3）： 166-170. doi:10.5414/cn110201 doi: 10.5414/cn110201
[16]	HUANG J， BAO L， PAN Y， et al. The predictive value of coronary artery calcification score combined with bone mineral density for the 2-year risk of cardiovascular events in maintenance hemodialysis patients［J］. Int Urol Nephrol， 2022， 54（4）： 883-893. doi:10.1007/s11255-021-02961-0 doi: 10.1007/s11255-021-02961-0
[17]	MARTINS M T S， MATOS C M， LOPES M B， et al. Vascular calcification by conventional X-ray and mortality in a cohort of predominantly African descent hemodialysis patients［J］. Int J Artif Organs， 2021， 44（5）： 318-324. doi:10.1177/0391398820962805 doi: 10.1177/0391398820962805
[18]	BAO W， HE L， ZHANG A. Compensatory elevated serum intermedin levels are associated with increased vascular calcification in hemodialysis patients［J］. Int Urol Nephrol， 2022， 54（11）： 3001-3007. doi:10.1007/s11255-022-03240-2 doi: 10.1007/s11255-022-03240-2
[19]	WEN W， IGNACIO P C， RITUVANTHIKAA S， et al. Intravenous sodium thiosulphate for vascular calcification of hemodialysis patients-A systematic review and meta-analysis［J］. Nephrol Dial Transplant， 2023， 38（3）： 733-745. doi:10.1093/ndt/gfac171 doi: 10.1093/ndt/gfac171
[20]	LIN R A， HSIEH J J， HUANG C C， et al. Circulating osteocalcin fractions are associated with vascular calcification and mortality in chronic hemodialysis patients［J］. Calcif Tissue Int， 2023， 113（4）： 416-425. doi:10.1007/s00223-023-01122-y doi: 10.1007/s00223-023-01122-y
[21]	WERIDA R H， ABOU-MADAWY S， ABDELSALAM M， et al. Omega 3 fatty acids effect on the vascular calcification biomarkers fetuin A and osteoprotegerin in hemodialysis patients［J］. Clin Exp Med，2022，22（2）：301-310. doi:10.1007/s10238-021-00740-w doi: 10.1007/s10238-021-00740-w
[22]	SADIOĞLU R E， ÜSTÜNER E， ERGÜN İ， et al. Warfarin is associated with the risk of vascular calcification in abdominal aorta in hemodialysis patients： A multicenter case-control study［J］. Turk J Med Sci， 2021， 51（5）： 2607-2615. doi:10.3906/sag-2104-221 doi: 10.3906/sag-2104-221
[23]	KANEDA H， NISHIYAMA T， OWADA K， et al. Extended-Hours Hemodialysis Without Dietary Restrictions Reduces Risk of Vascular Calcification［J］. J Med Cases， 2025， 16（8）： 300-308. doi:10.14740/jmc5146 doi: 10.14740/jmc5146
[24]	AKIYAMA K I， MORIYAMA T， HANAFUSA N， et al. Citric acid-based bicarbonate dialysate attenuates aortic arch calcification in maintenance hemodialysis patients： A retrospective observational study［J］. J Nephrol， 2023， 36（2）： 367-376. doi:10.1007/s40620-022-01470-2 doi: 10.1007/s40620-022-01470-2
[25]	HOLDEN R M， BOOTH S L， ZIMMERMAN D， et al. Inhibit progression of coronary artery calcification with vitamin K in hemodialysis patients （the iPACK-HD study）： A randomized， placebo-controlled multi-center， pilot trial［J］. Nephrol Dial Transplant， 2023， 38（3）： 746-756. doi:10.1093/ndt/gfac191 doi: 10.1093/ndt/gfac191

指标	HD组（n = 29）	HD + HDF组（n = 29）	HD + HDF + HP组（n = 29）	F/χ² 值	P值
血钙/（mmol/L）	2.59 ± 0.35	2.52 ± 0.38	2.61 ± 0.39	0.462	0.631
血磷/（mmol/L）	2.31 ± 0.37	2.03 ± 0.34^?	1.82 ± 0.40^?#	12.753	< 0.001
iPTH/（pg/mL）	451.32 ± 40.34	426.06 ± 36.19^?	401.34 ± 37.32^?#	12.552	< 0.001
dp-ucMGP/（ng/mL）	13.76 ± 2.51	11.52 ± 2.28^?	9.98 ± 2.04^?#	20.072	< 0.001
TC/（mmol/L）	4.62 ± 0.53	4.22 ± 0.58^?	4.18 ± 0.51^?	5.873	0.004
TG/（mmol/L）	1.89 ± 0.29	1.56 ± 0.31^?	1.60 ± 0.28^?	10.908	< 0.001
LDL-C/（mmol/L）	2.72 ± 0.38	2.24 ± 0.40^?	2.18 ± 0.37^?	17.272	< 0.001
HDL-C/（mmol/L）	1.12 ± 0.25	1.48 ± 0.27^?	1.49 ± 0.30^?	17.148	< 0.001
血管钙化率/［例（%）］	25（86.21）	20（68.97）	17（58.62）^?	5.501	0.064

项目	血管钙化组（n = 62）	非血管钙化组（n = 25）	χ²/t值	P值
性别（男/女）/例	39/23	14/11	0.357	0.550
年龄/岁	61.34 ± 7.43	46.42 ± 6.95	8.630	< 0.001
透析龄/月	55.20 ± 12.94	37.16 ± 10.38	6.205	< 0.001
BMI/（kg/m²）	21.67 ± 3.12	21.28 ± 2.94	0.536	0.593
SBP/（mmHg）	141.83 ± 15.34	136.59 ± 14.85	1.455	0.149
DBP（mmHg）	71.21±10.68	75.34±9.12	1.699	0.093
PP/（mmHg）	70.62 ± 14.28	61.25 ± 13.45	2.815	0.006
ALP/（U/L）	110.24 ± 22.45	106.27 ± 18.26	0.785	0.435
Scr/（μmol/L）	810.23 ± 158.68	794.24 ± 175.21	0.413	0.681
BUN/（mmol/L）	26.22 ± 6.42	25.86 ± 7.50	0.225	0.822
血钙/（mmol/L）	2.72 ± 0.36	2.21 ± 0.34	6.073	< 0.001
血磷/（mmol/L）	2.18 ± 0.42	1.74 ± 0.36	4.598	< 0.001
iPTH/（pg/mL）	445.32 ± 62.38	378.92 ± 56.22	4.617	< 0.001
ALB/（g/L）	40.21 ± 4.21	41.18 ± 4.75	0.937	0.351
FT/（ng/mL）	285.45 ± 42.55	279.32 ± 38.45	0.625	0.534
TC/（mmol/L）	4.48 ± 0.56	3.99 ± 0.63	3.562	< 0.001
TG/（mmol/L）	1.70 ± 0.32	1.64 ± 0.35	0.770	0.443
LDL-C/（mmol/L）	2.51 ± 0.40	2.06 ± 0.43	4.648	< 0.001
HDL-C/（mmol/L）	1.34 ± 0.28	1.42 ± 0.30	1.182	0.241
dp-ucMGP/（ng/mL）	15.89 ± 2.06	8.05 ± 1.74	16.756	< 0.001
透析模式（HD/HD + HDF/HD + HDF + HP）/例	25/20/17	4/9/12	5.501	0.064
吸烟史/［例（%）］	20（32.26）	7（28.00）	0.151	0.698
饮酒史/［例（%）］	12（19.35）	6（24.00）	0.234	0.628

自变量	B	S_b	Wald χ²	P值	OR	95%CI
年龄	1.234	0.385	8.452	0.004	1.123	1.034 ~ 1.346
透析龄	1.450	0.402	12.356	< 0.001	1.087	0.012 ~ 1.298
血钙	1.127	0.346	15.672	< 0.001	4.582	1.452 ~ 15.224
血磷	0.987	0.312	14.356	< 0.001	3.874	1.376 ~ 13.302
iPTH	0.882	0.294	10.234	< 0.001	2.034	1.173 ~ 8.375
dp-ucMGP	1.235	0.362	13.987	< 0.001	2.402	1.256 ~ 11.408

Study on the effects of different dialysis modes on serum dp⁃ucMGP levels and lipid distribution in patients and their correlation with vascular calcification

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