title: Calcium loading, calcium accumulation, and associated cardiovascular risks in dialysis patients.
abstract: Calcium and phosphate imbalances are important mutable risk factors for cardiovascular disease in chronic kidney disease (CKD). Nearly all dialysis patients require phosphate binders. These include traditional calcium-based compounds and, more recently, the calcium-free, metal-free, non-absorbed agent, sevelamer hydrochloride. Both binder types reduce serum phosphorus, but differ with respect to calcium load and metabolism. Absorption from calcium-based agents very likely promotes positive total calcium balance in many patients. Positive calcium balance is inappropriate in adults and may promote or accelerate soft-tissue and vascular calcification even in the absence of hypercalcemia. Calcium accumulation in heart and vascular tissues contributes to rapidly progressive cardiovascular calcification - a strong predictor of cardiovascular and all-cause mortality in stage 5 CKD. More than two-thirds of stage 5 CKD patients have calcification scores above the 75th percentile for matched controls -- scores associated with extremely high risk of cardiovascular events and death.
authors.affiliation: University North Carolina, Division of Nephrology and Hypertension, Chapel Hill, NC 27514, USA. philip_klemmer@med.unc.edu
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Klemmer
mesh_terms: D002118:Calcium / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003956:Dialysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D010710:Phosphates / Q000378:metabolism; D012306:Risk
chemical_list: D010710:Phosphates; D002118:Calcium