Document Detail


Efficacy of hyperphosphatemia control in the progression of chronic renal failure and the prevalence of cardiovascular calcification.
MedLine Citation:
PMID:  19203546     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIMS: Chronic kidney disease mineral- and bone disorder (CKD-MBD) has been studied more often in dialysis than in predialysis CKD patients. The association between efficacy of hyperphosphatemia control and chronic renal failure (CRF) progression, prevalence of bone disease and cardiovascular calcification was the objective of the present investigation. MATERIAL AND METHODS: 42 patients with CKD in Stage 5, regularly monitored for 5 years, were divided into Group 1 of 20 patients with normal serum phosphate (sPO4) levels and Group 2 of 22 patients with hyperphosphatemia registered at the majority of checks. Serum urea, creatinine, calcium (sCa) and sPO4 levels were regularly determined in the retrospective 5-year period. At the end of this period iPTH, bone alkaline phosphatase-BAP and inflammation markers (CRP, fetuin-A) were measured, valvular and arterial calcifications were detected by B mode echocardiogram and soft-tissue native radiograms of the pelvis and the wrist. RESULTS: Progression of CRF (1/sCr over time) was faster in Group 2 than in Group 1 (b = -0.0577 vs. -0.0288, p = 0.003) during the study period. Average BAP and iPTH values were similar in both groups and 23/42 patients had PTH > 300 pg/ml. Arterial and valvular calcifications were found in 5/23 patients from Group 1 and 14/22 patients from Group 2 (p = 0.011). Linear regression analysis revealed sPO4 as a predictor for total calcification number, inflammatory diseases as a predictor for valvular calcifications, while sPO4 and iPTH were predictors for arterial calcifications. CONCLUSIONS: More than half the patients with Stage 5 CKD not yet on dialysis exhibited elevated PTH. Faster CRF progression and frequent arterial and valvular calcifications were seen in patients with poor phosphate control and sPO4 was selected as an independent predictor of total calcification score.
Authors:
V Lezaic; B Tirmenstajn-Jankovic; D Bukvic; B Vujisic; M Perovic; N Novakovic; V Dopsaj; I Maric; Lj Djukanovic
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical nephrology     Volume:  71     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-02-10     Completed Date:  2009-03-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  21-9     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Clinical Center Beograd, Lazarevac, Serbia. visnjal@eunet.yu
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MeSH Terms
Descriptor/Qualifier:
Aged
Calcinosis / epidemiology*
Cardiovascular Diseases / epidemiology*
Cohort Studies
Female
Humans
Hyperphosphatemia / complications,  pathology,  prevention & control*
Kidney Failure, Chronic / complications*,  pathology,  therapy
Male
Middle Aged
Prevalence
Retrospective Studies
Treatment Outcome

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