Vascular calcification and disordered mineral metabolism in dialysis patients.
Vascular calcification is an active, cell-mediated process that can involve either the intima or media of the blood vessels. The current methods used to clinically measure vascular calcification cannot distinguish between intimal (invariably atherosclerotic) and medial calcification. The high calcification scores seen in patients with end-stage renal disease likely represent a composite of high calcification burden in both sites. The severity of vascular calcification has been associated with a variety of findings including left ventricular hypertrophy and angiographic vascular stenosis as well as with all-cause and cardiovascular mortality. There is increasing evidence that disordered mineral metabolism participates in the process of vascular calcification and is one of the mechanisms whereby hyperphosphatemia, hypercalcemia, and hyperparathyroidism enhance cardiovascular and all-cause mortality of end-stage renal disease patients. There are no studies showing improved outcomes of ESRD patients with aggressive control of disordered mineral metabolism. However, the preponderance of evidence argues strongly in favor of aggressive management of these abnormalities from starting early in the course of chronic kidney disease in the hope of improving patient outcomes.
Kalpakian
Mary Alice
MA
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA.
Mehrotra
Rajnish
R
D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002114:Calcinosis / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism* / Q000517:prevention & control; D002614:Chelating Agents / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D008903:Minerals / Q000378:metabolism*; D011073:Polyamines / Q000627:therapeutic use; D006435:Renal Dialysis; D000069603:Sevelamer; D017539:Tunica Intima / Q000378:metabolism / Q000473:pathology; D017540:Tunica Media / Q000378:metabolism / Q000473:pathology; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism* / Q000517:prevention & control; D014807:Vitamin D / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D002614:Chelating Agents; D008903:Minerals; D011073:Polyamines; D014807:Vitamin D; D000069603:Sevelamer