title: Different risk factors for vascular calcification in end-stage renal disease between diabetics and nondiabetics: the respective importance of glycemic and phosphate control.
abstract: Vascular calcification is highly prevalent in dialysis patients, and significantly increases cardiovascular mortality. The presence and progression of vascular calcification is significantly associated with chronic inflammation and malnutrition. Disorders of mineral metabolism, particularly hyperphosphatemia, have been emphasized as risk factors for vascular calcification. Although vascular calcification has been reported to be highly prevalent in diabetic patients with end-stage renal disease (ESRD), the risk factors for vascular calcification in these patients have not been fully explored. Through a review of the literature and our recent studies examining vascular calcification in ESRD patients, hyperphosphatemia is significantly associated with vascular calcification in nondiabetic ESRD patients, while it may not be a significant risk factor for vascular calcification in diabetic ESRD patients. In diabetic patients, vascular calcification occurs long before the initiation of dialysis therapy, and the factors associated with vascular calcification in non-uremic diabetics appear to be hyperglycemia and related metabolic disorders, such as increased glycation and oxidative stress. In diabetic ESRD patients, hyperglycemia is also suggested to be a significant factor associated with the progression of vascular calcification. Thus, the importance of glycemic and phosphate control is suggested to be emphasized in diabetic and nondiabetic ESRD patients, respectively, for prevention of the progression of vascular calcification.
authors: Osaka City University Graduate School of Medicine, Osaka, Japan. ish@med.osaka-cu.ac.jp
authors: Eiji
authors: E
authors: Ishimura
authors: Senji
authors: S
authors: Okuno
authors: Hiromichi
authors: H
authors: Taniwaki
authors: Akane
authors: A
authors: Kizu
authors: Takao
authors: T
authors: Tsuchida
authors: Atsushi
authors: A
authors: Shioi
authors: Tetsuo
authors: T
authors: Shoji
authors: Tsutomu
authors: T
authors: Tabata
authors: Masaaki
authors: M
authors: Inaba
authors: Yoshiki
authors: Y
authors: Nishizawa
mesh_terms: D000818:Animals; D002114:Calcinosis / Q000097:blood / Q000473:pathology*; D003920:Diabetes Mellitus / Q000097:blood / Q000473:pathology*; D038321:Glycemic Index / Q000502:physiology; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000209:etiology / Q000473:pathology; D054559:Hyperphosphatemia / Q000097:blood / Q000209:etiology / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000473:pathology*; D010710:Phosphates / Q000378:metabolism; D012307:Risk Factors; D014652:Vascular Diseases / Q000097:blood / Q000209:etiology / Q000473:pathology*
chemical_list: D010710:Phosphates