title: The Strategy to Prevent and Regress the Vascular Calcification in Dialysis Patients.
abstract: The high prevalence of arterial calcification in end-stage renal disease (ESRD) is far beyond the explanation by common cardiovascular risk factors such as aging, diabetes, hypertension, and dyslipidemia. The finding relies on the fact that vascular and valvular calcifications are predictors of cardiovascular diseases and mortality in persons with chronic renal failure. In addition to traditional cardiovascular risk factors such as diabetes mellitus and blood pressure control, other ESRD-related risks such as phosphate retention, excess calcium, and prolonged dialysis time also contribute to the development of vascular calcification. The strategies are to reverse "calcium paradox" and lower vascular calcification by decreasing procalcific factors including minimization of inflammation (through adequate dialysis and by avoiding malnutrition, intravenous labile iron, and positive calcium and phosphate balance), correction of high and low bone turnover, and restoration of anticalcification factor balance such as correction of vitamin D and K deficiency; parathyroid intervention is reserved for severe hyperparathyroidism. The role of bone antiresorption therapy such as bisphosphonates and denosumab in vascular calcification in high-bone-turnover disease remains unclear. The limited data on sodium thiosulfate are promising. However, if calcification is to be targeted, ensure that bone health is not compromised by the treatments.
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung City, Taiwan.
authors.forename: Nai-Ching
authors.initials: NC
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Chih-Yang
authors.identifier: 0000-0003-1151-9628
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Chien-Liang
authors.identifier: 0000-0002-9508-8396
authors.initials: CL
authors.lastname: Chen
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D061205:Vascular Calcification / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D014808:Vitamin D Deficiency / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D014813:Vitamin K Deficiency / Q000097:blood / Q000209:etiology / Q000517:prevention & control
chemical_list: D010710:Phosphates