Risk factors for coronary artery calcification in Chinese patients undergoing maintenance hemodialysis: a meta-analysis
Bibliographic record
Abstract
BACKGROUND: Chronic kidney disease (CKD) progression to end-stage renal disease (ESRD) increases cardiovascular disease (CVD) risk, with coronary artery calcification (CAC) affecting 70% of Chinese maintenance hemodialysis (MHD) patients. Prolonged MHD treatment is linked to calcium-phosphorus imbalance and accelerated CAC progression. However, conflicting findings on CAC risk factors persist due to methodological heterogeneity in existing studies. OBJECTIVE: To systematically analyze the risk factors for coronary artery calcification in patients undergoing maintenance hemodialysis in China. METHODS: We conducted a computer-assisted search of ten databases, including PubMed, Web of Science, CBM, Wanfang, CNKI, and VIP, for observational studies (cohort, case-control, and cross-sectional studies) published from inception to October 21, 2024, on risk factors for coronary artery calcification (CAC) in Chinese patients with maintenance hemodialysis (MHD). The studies were independently screened by two investigators according to the PRISMA guidelines and diagnosed with coronary artery calcification through imaging techniques (CT). Odds ratios (ORs) and 95% confidence intervals (CIs) were used for the reported outcomes. The quality of the studies was assessed using the Newcastle-Ottawa Scale. A meta-analysis of the included data was performed using either a random effects model or a fixed effects model, we performed a meta-analysis using the Stata 17.0 software. RESULTS: The review included 24 studies with a total sample size of 2,875 patients. A meta-analysis of these 24 studies (n = 2875) found that diabetes mellitus (OR = 2.32, 95% CI 1.37-3.27) and elevated iPTH (OR = 1.59, 95% CI 1.21-1.96) were the strongest predictors of an increased risk of coronary artery calcification (CAC) in Chinese maintenance hemodialysis (MHD) patients. Additionally, elevated high-sensitivity C-reactive protein (hs-CRP) levels, elevated serum calcium, advanced age, longer duration of dialysis treatment, elevated serum phosphorus, and elevated sclerostin (SOST) levels were significant predictors of an increased risk of concurrent CAC in Chinese MHD patients. However, the correlation between hypertension, serum magnesium, fibroblast growth factor-23 (FGF-23), alkaline phosphatase (ALP), and MHD with concomitant CAC was not significant, likely due to the wide variation in sample size and study type. CONCLUSION: Diabetes mellitus and elevated iPTH are the most significant clinical risk factors for coronary artery calcification (CAC) in Chinese maintenance hemodialysis (MHD) patients, and healthcare professionals should prioritize this population. Additionally, monitoring calcium and phosphorus metabolism, along with inflammatory markers (e.g., hs-CRP, SOST), can further reduce the risk of cardiovascular disease. Early health education and targeted, individualized treatment strategies for high-risk groups are recommended to prevent and delay the onset and progression of CAC in MHD patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.012 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.035 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".