The clinical significance of vascular calcification in young patients with end-stage renal disease.
Mortality statistics of young adults with childhood-onset end-stage renal disease (ESRD) show that cardiovascular disease (CVD) is responsible for most deaths on dialysis and after transplantation. This is most likely explained by the presence of a multitude of traditional and non-traditional risk factors in uremia, promoting the combination of classical atherosclerosis, uremic vasculopathy, and uremic cardiomyopathy. Vascular (arterial) calcifications occur with a high prevalence in young adults and their presence correlates with non-traditional risk factors, markers of inflammation, intake of calcium-containing phosphate binders, and the calcium-phosphorus product in serum. This might be explained by a high positive calcium and phosphorus balance in ESRD patients, which may be comparatively higher in the young. In addition, treatment with active vitamin D preparations may enhance the positive calcium and phosphorus balance and have a direct calcifying effect on the arterial wall. The biological process of vascular calcification resembles osteogenesis. These data indicate that vascular calcifications are related to non-traditional risk factors, inflammatory mechanisms, and disturbances in calcium and phosphorus metabolism in uremia. They provide strong evidence for a change in the current management of renal osteodystrophy in children and adolescents with ESRD.
Querfeld
Uwe
U
Department of Pediatric Nephrology, Charité Children's Hospital, 13353 Berlin, Germany. uwe.querfeld@charite.de
D000293:Adolescent; D001161:Arteriosclerosis / Q000209:etiology / Q000473:pathology; D002114:Calcinosis / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D012307:Risk Factors; D014652:Vascular Diseases / Q000473:pathology*