Document Detail


Cardiovascular calcification in patients with end-stage renal disease: a century-old phenomenon.
MedLine Citation:
PMID:  12410860     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The mortality risk from cardiovascular disease is increased in patients with end-stage renal disease (ESRD). This is due to both traditional and dialysis-specific factors. Recently, a number of the dialysis-specific risk factors have been implicated in the pathogenesis of cardiovascular calcification. These include: hyperphosphatemia, high calcium-phosphate (Ca x P) product, elevated parathyroid hormone levels, duration of dialysis, and treatment with calcium-containing phosphate binders and vitamin D analogs. The recent availability of electron beam computed tomography (EBCT) has triggered increased awareness of the occurrence of cardiovascular calcification in ESRD patients. Given the development of transient hypercalcemia with calcium-containing binders, a link between calcium load from use of calcium-containing phosphate binders and development coronary calcification has been proposed. However, a causal relationship between use of these agents and cardiovascular calcification has not been established. Moreover, this phenomenon had been recognized over a century ago, long before these phosphate binders became available. Although its pathogenesis is likely to be multifactorial, available data strongly implicate elevated serum phosphorus as the primary culprit. Furthermore, the risk of calcification may be aggravated by vitamin D therapy, particularly in patients with severe secondary hyperparathyroidism. Therefore, achieving vigorous control of serum phosphorus, Ca x P product and parathyroid hormone level might decrease cardiovascular calcification and improve survival of patients on maintenance hemodialysis. Since calcium acetate is the most cost-effective phosphate binder available, we recommend that it should remain the first line treatment of hyperphosphatemia in patients with ESRD.
Authors:
Wajeh Y Qunibi; Charles A Nolan; J Carlos Ayus
Publication Detail:
Type:  Historical Article; Journal Article; Review    
Journal Detail:
Title:  Kidney international. Supplement     Volume:  -     ISSN:  0098-6577     ISO Abbreviation:  Kidney Int. Suppl.     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2002-11-04     Completed Date:  2008-07-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7508622     Medline TA:  Kidney Int Suppl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S73-80     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Department of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA.
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MeSH Terms
Descriptor/Qualifier:
Calcinosis / etiology*,  history,  metabolism
Calcium / metabolism
Chelating Agents / adverse effects
Coronary Artery Disease / etiology*,  history,  metabolism
Dialysis / adverse effects
History, 20th Century
History, 21st Century
Humans
Hypercalcemia / complications
Hyperphosphatemia / complications*,  drug therapy,  etiology,  history
Kidney Failure, Chronic / complications*,  history,  metabolism,  therapy
Muscle, Smooth, Vascular / metabolism
Parathyroid Hormone / metabolism
Phosphorus / metabolism
Risk Factors
Vitamin D / adverse effects,  analogs & derivatives
Vitamins / adverse effects
Chemical
Reg. No./Substance:
0/Chelating Agents; 0/Parathyroid Hormone; 0/Vitamins; 1406-16-2/Vitamin D; 7440-70-2/Calcium; 7723-14-0/Phosphorus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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