Determinants of coronary vascular calcification in patients with chronic kidney disease and end-stage renal disease: a systematic review.
BACKGROUND
Vascular calcification (VC) is a recognized process involved in senescence and atherosclerosis. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are conditions associated with metabolic disorders related to soft tissue calcification.


METHODS
We performed a systematic review of the literature confined to patients with CKD or ESRD with clinical observations of VC. Case reports of calciphylaxis were excluded. We identified 30 studies over 20 years: 11 prospective cohort, 7 cross-sectional, 11 case-control, and 1 retrospective cohort; n = 2918 subjects, mean age 51 years, 59% men and 41% women. Imaging methods used included: x-ray 43%, computed tomography 30%, ultrasound 17%, and other methods 10%.


RESULTS
The most consistent determinants of VC were older age and dialysis vintage. Eight analyses determined a relationship between VC and measures of calcium-phosphate balance while 20 analyses specifically did not find such a relationship. Three studies suggested the degree of calcium loading, treatment with phosphate binders, or treatment with vitamin D analogues were related to VC. When taken into consideration, the lipid profile (primarily low high-density lipoprotein cholesterol, elevated triglycerides, elevated low-density lipoprotein, and elevated total cholesterol) were predictive factors in four analyses.


CONCLUSIONS
VC is a common observation in CKD and ESRD and is mainly related to age, length of time on dialysis therapy, and possibly dyslipidemia. The calcium-phosphorus balance and its related treatments are likely not related to this unique form of vascular calcification. Further research into the determinants and potential treatments for vascular calcification is warranted.
Department of Medicine, Divisions of Cardiology, Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA. pmc975@yahoo.com
Peter A
PA
McCullough
Keisha R
KR
Sandberg
Francis
F
Dumler
Jose E
JE
Yanez
D000367:Age Factors; D002114:Calcinosis / Q000209:etiology / Q000378:metabolism*; D002118:Calcium / Q000378:metabolism; D002908:Chronic Disease; D003331:Coronary Vessels / Q000378:metabolism / Q000473:pathology*; D003956:Dialysis / Q000009:adverse effects; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism; D008074:Lipoproteins / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000378:metabolism; D013997:Time Factors; D014652:Vascular Diseases / Q000209:etiology / Q000378:metabolism* / Q000473:pathology
D008074:Lipoproteins; D010758:Phosphorus; D002118:Calcium