[Cardiovascular calcification and accelerated atherosclerosis in chronic kidney disease].
Cardiovascular disease is the first cause of morbidity and mortality in dialysis patients. Hyperphosphatemia and elevated serum calcium-phosphate levels have recently been investigated as inducing factors on extraskeletal calcification in this population. In vitro studies demonstrated that human aortic smooth muscle cells calcify when incubated in a high phosphate medium, where calcium and calcitriol are not changed. Furthermore, the lack of inhibitory proteins, such as fetuin and matrix Gla protein, is a possible main determinant of calcium-phosphate deposition in soft tissues. The classical treatment of hyperphosphatemia and secondary hyperparathyroidism in dialysis patients consists of calcium-based phosphate binders and calcitriol administration. Unfortunately, this "first-generation" therapy is not free of dramatic side effects. New free-calcium and -aluminum phosphate binders, new vitamin D metabolites, and calcimimetics are examples of "second-generation" therapies that may prevent vascular calcification and possibly prevent some of the burden of cardiovascular disease in uremia.
Cozzolino
Mario
M
U.O. di Nefrologia e Dialisi, A.O. San Paolo, Polo Universitario, Milano. mariocozzolino@hotmail.com
Butti
Alessandra
A
Chiarelli
Giusy
G
Rocca-Rey
Lisa
L
Santagostino
Gaia
G
Gallieni
Maurizio
M
Brancaccio
Diego
D
D000818:Animals; D001161:Arteriosclerosis / Q000209:etiology* / Q000517:prevention & control; D002114:Calcinosis / Q000209:etiology* / Q000517:prevention & control; D002117:Calcitriol / Q000627:therapeutic use; D002120:Calcium Channel Agonists / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D002478:Cells, Cultured; D002614:Chelating Agents / Q000627:therapeutic use; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D051379:Mice; D018345:Mice, Knockout; D028044:Phosphate-Binding Proteins / Q000627:therapeutic use; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D014511:Uremia / Q000150:complications
D002120:Calcium Channel Agonists; D002614:Chelating Agents; D028044:Phosphate-Binding Proteins; D010710:Phosphates; D002117:Calcitriol