维持性血液透析患者主动脉钙化相关影响因素分析

目的：探讨维持性血液透析（MHD）患者主动脉钙化的相关影响因素。方法：采用胸部正位X线成像技术检测183例MHD患者主动脉钙化情况,将入选患者分为主动脉钙化组（A组）和主动脉无钙化组（B组）,透析前抽血检测血钙、血磷、全段甲状旁腺激素（iPTH）、C反应蛋白（CRP）和血清白蛋白（Alb）等指标,并计算钙磷乘积,比较两组年龄、透析龄和血清学指标的差异,将上述指标与主动脉钙化进行相关性分析,并对筛选出来的危险因素进行非条件Logistic回归分析。结果：A组和B组在年龄、透析龄、血磷、钙磷乘积和CRP水平方面,差异均有统计学意义（P〈0.01或P〈0.05）;MHD患者主动脉钙化的相关影响因素包括：年龄、透析龄、血磷、钙磷乘积及CRP;Logistic回归分析表明,年龄、透析龄和血磷是主动脉钙化的独立危险因素（P〈0.01）。结论：MHD患者主动脉钙化相当常见,主动脉钙化与年龄、透析龄、钙磷代谢和炎症状态有关。     

维持性血液透析116例患者颈动脉粥样硬化中钙磷代谢的研究

目的：研究维持血液透析（MHD）患者颈动脉粥样硬化中钙磷代谢变化。方法：回顾性分析我院2008年6月～2011年6月超过3个月的MHD患者,进行超声检查患者颈动脉粥样硬化的情况,根据结果分为：无颈动脉粥样硬化对照组及颈动脉粥样硬化组,采用全自动生化分析仪常规检测血清白蛋白（Alb）、c反应蛋白（CRP）、血钙、血磷及PrH等。结果：研究结果表明：颈动脉粥样硬化组患者较无颈动脉粥样硬化对照组患者钙磷代谢紊乱尤为突出,提示血液透析清除血磷不充分。进而导致颈动脉粥样硬化的发生与发展。采用相关分析检测MHD患者血CRP、Alb与颈动脉平均IMT存在相关性（r=－0．21。P〈0．05;r=0．28,P〈0．05）。结论：钙磷代谢紊乱、PTH异常及炎症反应等参与了MHD患者颈动脉粥样硬化的发生与发展。     

维持血液透析患者主动脉弓钙化发生情况及相关因素分析

目的观察维持性血液透析（MHD）患者主动脉弓钙化发生的情况并分析其相关因素。方法观察220例MHD患者胸部正位片主动脉弓钙化的发生情况；将其年龄、性别、原发病、血压、心胸比、血常规及血生化结果与主动脉弓钙化进行相关性分析，比较有钙化组和无钙化组的上述指标。结果82例发生主动脉弓钙化，其中48例透析前已存在主动脉弓钙化,34例透析后（21.15±12.12）月出现。钙化组的年龄、MHD时间、心胸比、钙磷乘积、脉压、球蛋白（G）明显高于非钙化组，全段甲状旁腺激素（iPTH）、白蛋白（A）明显低于非钙化组。结论MHD患者发生主动脉弓钙化的几率很高；影响主动脉弓钙化的因素主要为年龄、脉压、钙磷乘积。     

冠状动脉钙化对维持性血液透析患者心脏结构和功能的影响及其相关因素评估

目的 观察冠状动脉钙化（CAC）对维持性血液透析（MHD）患者心脏结构和功能的影响，探讨引起CAC的相关危险因素。 方法 40例MHD患者经螺旋CT扫描，了解合并CAC的患者比例，并计算其钙化积分以评估CAC程度。应用心脏彩超和颈动脉超声检查心脏形态、功能及颈动脉斑块，进一步分析MHD患者各项临床指标与CAC的关系。 结果 25例MHD患者（62.5%）合并不同程度的CAC，平均钙化积分为672.3。钙化组（CAC组）与无钙化组（NCAC组）心脏形态及左室顺应性、颈动脉内膜中层厚度（IMT）、斑块发生率、斑块积分差异均有统计学意义。缺血性心脏病和心衰竭发生率均以CAC组为高。4例死于心脏疾病患者均存在CAC。颈动脉斑块阳性组IMT平均为（0.86±0.15） mm，钙化发生率为81%，冠状动脉钙化积分为867±198，均明显高于斑块阴性组[分别为（0.73±0.14） mm,42%,437±176,P < 0.05]。CAC组年龄、糖尿病或肥胖患者比例、透析时间、血磷、C反应蛋白（CRP）、胆固醇和低密度脂蛋白水平、钙磷乘积、颈动脉IMT、斑块积分均高于NCAC组。多元逐步回归分析显示，年龄、透析时间与CAC密切相关。 结论 MHD患者普遍存在CAC。CAC与心脏结构、功能的变化及颈动脉粥样硬化相关。糖尿病及肥胖患者比例、钙磷代谢及脂代谢异常、透析时间、CRP、动脉粥样硬化是CAC的相关因素。年龄和透析时间是CAC的独立危险因素。     

维持性血透患者颈动脉内膜中层厚度增厚及其影响因素分析

目的研究维持性血透(MHD)患者颈动脉内膜中层厚度(IMT)增厚情况并分析其可能影响因素。方法75例MHD患者为MHD组,30例健康体检者为对照组。采用高频B超检测其颈动脉IMT值,并记录各患者的临床及生化数据。MHD组按IMT值分为正常、异常和增厚3个亚组。对各组数据进行比较并对IMT的各危险因素进行相关性分析。结果MHD组患者颈动脉IMT值明显大于对照组[(1.03±0.42)比(0.63±0.11)mm,P<0.01]。IMT增厚组年龄、收缩压、血浆白蛋白、前白蛋白、胆固醇、血磷水平与IMT正常组相比,差异有统计学意义(P<0.05或P<0.01)。IMT异常组的收缩压、血磷水平明显高于IMT正常组(P<0.01)。单因素相关分析(Model1)结果显示,MHD患者颈动脉IMT与年龄(r=0.247,P=0.032)、收缩压(r=0.758,P<0.01)、血磷(r=0.604,P<0.01)呈显著正相关;与血浆白蛋白(r=-0.292,P=0.011)、前白蛋白(r=-0.681,P<0.01)呈显著负相关。经控制年龄因素后的偏相关分析(Model2)结果与Model1结果一致。多元线性回归分析结果显示高收缩压(B=0.446,P<0.01)、低前白蛋白(β=-0.336,P<0.01)和高血磷(β=0.248,P=0.01)是颈动脉IMT增厚的独立影响因素。结论MHD患者颈动脉IMT明显增厚。高收缩压、低前白蛋白及高血磷是颈动脉IMT增厚的独立危险因素并可能与MHD患者动脉粥样硬化进展相关。     

低钙透析液对血液透析伴继发性甲状旁腺功能减退患者的临床研究

目的：探讨应用含钙1.25mmol／L浓度透析液进行血液透析对维持性血液透析（MHD）伴相继发性甲状旁腺功能减退患者的钙磷代谢和甲状旁腺功能的影响。方法：选择MHD6个月以上、病情稳定、连续2次血iPTH〈100pg／ml的患者60例,随机分为对照组（含钙1.5mmol／L透析液）和治疗组（含钙1.25mmol／L透析液）,每组各30例,观察时间6个月。观察并记录研究前、研究后l、3、6个月等不同时期患者血iPTH、血清校正钙、磷、钙磷乘积等指标的变化以及相关不良反应。另外,选择使用含钙浓度1.5mmol／L和1.25mmol／L透析液进行MHD的患者各20例,检测单次透析前、透析结束时以及下次透析前的血清校正钙、磷和iPTH浓度。结果：（1）治疗组单次透析后血清校正钙、磷和钙磷乘积均较透析前明显下降,iPTH浓度较透前明显升高,P〈0.01;而对照组上述血钙和iPTH浓度无明显变化;（2）透析后治疗组血清校正钙和钙磷乘积较对照组明显下降,血iPTH浓度较对照组明显升高,P〈0.01;两组血磷浓度差异无统计学意义。（3）治疗组1个月后血清校正钙、磷和钙磷乘积较治疗前开始下降,3个月后进一步下降,P〈0.05,6个月后各项指标趋于稳定;iPTH水平1个月后较治疗前明显升高,并随着治疗时间的延长,逐渐升高,P〈0.01。（4）对照组治疗后1、3、6个月上述指标与治疗前比较差异无统计学意义。（5）两组透析过程中出现的不良反应差异无统计学意义。结论：对于血iPTH〈100pg／ml MHD患者应用含钙1.25mmol／L透析液进行血液透析能较好地控制其血清校正钙、磷、钙磷乘积水平,有效地改善被过度抑制的甲状旁腺功能,并且安全性良好。     

慢性肾脏疾病患者钙磷代谢的控制对血管钙化的影响

目的观察慢性肾脏疾病（chronickidneydisease,CKD）3期开始纠正钙磷代谢紊乱对患者血管钙化的影响。方法选择本院门诊或住院的CKD3～4期非透析患者80例,按随机数字表法分为干预组及观察组,每组40例。干预组进行钙磷代谢紊乱严格干预,观察组则给予CKD的常规治疗,观察并比较2组患者的血压、血尿素氮、血肌酐、血钙、血磷、全段甲状旁腺素（intactparathyroidhor—mone,iPTH）、血红蛋白（hemoglobin,Hb）、血白蛋白等指标,同时通过腹部、骨盆、手部x线平片进行血管钙化的定量测量。结果2组治疗后的血钙、血磷、钙磷乘积、iPTH、收缩压（systolicbloodpressure,SBP）和血白蛋白较治疗前明显变化,而舒张压（diastolicbloodpressure,DBP）和Hb较治疗前无明显变化（P〉O．05）。干预组血钙治疗后高于治疗前（P〈O．05）,亦高于对照组（P〈O．05）;干预组和观察组血磷和血白蛋白治疗前相比均升高,但观察组升高更显著（P〈0．05）。干预组和观察组血SBP和iFrrH与治疗前相比均降低,但干预组降低更显著（P〈O．05）。干预组发生血管钙化4例,观察组发生血管钙化10例,干预组血管钙化的发生率低于观察组（P〈O．05）。结论钙磷代谢紊乱参与了CKD血管钙化的进展,在CKD3期开始干预可明显延缓其进展,提高患者预后质量。     

维持性血液透析患者发生不良心血管事件危险因素的分析

目的：探讨维持性血液透析患者发生不良心血管事件的危险因素。方法：选取2009年1月～12月于我科维持性血液透析患者58例,透析时间≥3月。根据不良心血管事件确认标准分为有心血管疾病组28例,无心血管事件组30例。记录两组患者年龄、性别、原发病、透析龄;同时记录血生化指标：血尿酸、血红蛋白、血浆白蛋白、总蛋白、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、血钙、血磷、钙磷乘积、全段甲状旁腺素（iPTH）、25-（OH）D3、碱性磷酸酶、尿素氮、肌酐水平。结果：有心血管事件组年龄、透析龄明显高于无心血管事件组（P〈0.01）;有心血管事件组患者血尿酸、血钙水平高于无心血管事件组（P〈0.05）,而血25-（OH）D3水平在有心血管事件组明显低于无心血管事件组（P〈0.01）;二分类Lo-gistic回归分析显示年龄、透析龄、低密度脂蛋白、钙磷乘积、25-（OH）D3、血尿酸是血液透析患者发生不良心血管事件的重要危险因素。结论：心血管疾病是血液透析患者常见的并发症之一,年龄、透析龄、低密度脂蛋白、钙磷乘积、25-（OH）D3、血尿酸是血透患者发生不良心血管事件的重要危险因素。     

调整腹透液钙浓度对尿毒症患者颈动脉粥样硬化的影响

目的观察调整腹透液钙浓度对持续性不卧床腹膜透析（㈣）患者颈动脉粥样硬化的影响。方法在规律性腹膜透析随访的患者中选择30例伴有颈动脉粥样硬化的患者，先予患者继续使用标准钙腹透液6个月后改用低钙腹透液（Baxter PD4：Ca^2＋1．25mmol／L，其余成分不变），同时增加碳酸钙用量，继续观察12个月，回顾分析患者的血清钙、磷、钙磷乘积及甲状旁腺素（iPTH）水平，颈动脉内-中膜厚度（IMT）、颈动脉血流阻力指数（R1）、颈动脉粥样斑块数量和超声分型的变化。同时观察使用低钙腹透液的不适症状。结果在继续使用标准钙腹透液的6个月中，患者血钙水平逐渐增加，颈动脉IMT增厚，RI增加，差异均有统计学意义。换用低钙腹透液治疗3个月后，颈动脉IMT变薄，RI较前明显下降（P〈0．05），血钙、磷及钙磷乘积明显下降（P〈0．01），iPTH明显增加（P〈0．01）。患者碳酸钙的每日口服剂量也由（2．27±0．41）g增加至（3．35±0．22）g（P（0．05）。在随后的9个月中，血钙、钙磷乘积均稳定在正常范围，血磷降至正常，iPTH 150ng／L左右；颈动脉IMT变薄（P〈0．01）、RI下降（P〈0．01），颈动脉粥样硬化斑块的超声分型及数量变化有统计学意义。治疗过程中，1例死亡，2例自行退出，其余患者均未有明显低钙抽搐、低血压等发生。结论低钙透析能显著减轻腹膜透析患者钙磷代谢紊乱对血管的毒性作用，有助于尿毒症患者颈动脉粥样硬化的转归。     

不同钙浓度腹透液对尿毒症患者颈动脉粥样硬化影响的超声评价及相关因素分析

目的：观察使用不同钙浓度腹透液行持续性不卧床腹膜透析（CAPD）的尿毒症患者颈动脉粥样硬化的超声学改变。并行相关因素分析。方法：将40例初行CAPD的尿毒症患者随机分为2组：标准钙腹透液治疗组（A组，20例）和低钙腹透液治疗组（B组，20例），行正规CAPD治疗并配合碳酸钙口服。观察治疗12个月前后患者颈动脉内-中膜厚度（IMT）、颈动脉粥样斑块数量和超声分型的变化，以及血清钙、磷、钙磷乘积、甲状旁腺素（iPTH）的改变。结果：两组患者初行CAPD治疗前颈动脉IMT、粥样斑块的数量、检出率和超声分型无差异。经过12个月的治疗随访后，B组患者颈动脉IMT、斑块发生率及溃疡斑的检出率显著低于A组（P〈0．05）。与此同时，B组患者的血清钙、磷及钙磷乘积也有着显著意义地降低（P〈0．05或P〈0．01），且均低于治疗后的同期A组患者（P〈0．05或P〈0．01），iPTH则有显著意义地上升（P〈0．01）。整个治疗过程中，两组患者均未有明显低钙抽搐、低血压等情况发生。结论：钙磷代谢紊乱可加重尿毒症CAPD患者的血管损伤，低钙透析液有助于减轻患者的钙磷代谢紊乱，减轻其对血管损伤，延缓颈动脉粥样硬化的进展。     

Significant association between the presence of peripheral vascular calcification and lower serum magnesium in hemodialysis patients

AIM: Vascular calcification, which significantly increases cardiovascular and other causes of mortality, is highly prevalent in hemodialysis patients. The aim of the present study was to examine the association between serum magnesium levels and vascular calcification in hemodialysis patients. METHODS: 390 nondiabetic patients on maintenance hemodialysis (226 males and 164 females, 59 +/- 13 years) were examined. Hand roentgenography was performed in each patient, and visible vascular calcification of the hand arteries was evaluated. Blood was drawn to measure serum calcium, phosphate, magnesium and intact parathyroid hormone levels. RESULTS: There were 52 patients (38 males and 14 females) with vascular calcification, and 338 (188 males and 150 females) without. Serum phosphate was significantly higher in the former compared with the latter group (p < 0.005); serum intact parathyroid hormone was significantly higher (p < 0.05), whereas serum calcium was not statistically different between the two groups. Serum magnesium was significantly lower in patients with vascular calcification than in those without (2.69 +/- 0.28 vs. 2.78 +/- 0.33 mg/dl, p < 0.05). Multivariate logistic regression analysis revealed that serum magnesium concentration was a significant independent factor associated with the presence of vascular calcification in hemodialysis patients (odds ratio 0.28, 95% CI 0.09 - 0.92/1 mg/dl increase in serum magnesium, p = 0.036) after adjustment for age, gender, duration of hemodialysis, calcium, phosphate and intact parathyroid hormone concentrations. CONCLUSION: Hypomagnesemia is significantly associated with the presence of vascular calcification of the hand arteries, independent of serum calcium and phosphate levels. These results suggest that higher serum magnesium concentrations may play an important protective role in the development of vascular calcification in hemodialysis patients, and that magnesium concentration of dialysis fluid may be reconsidered in view of preventing vascular calcification in hemodialysis patients.     

Intracranial artery calcification in hemodialysis patients

Intracranial artery calcification is an independent risk factor for ischemic stroke, and while it is frequently observed on computed tomographic images of the brain in hemodialysis patients, its distribution has not been well studied. Fifty patients on maintenance hemodialysis were enrolled in this study. We divided the patients with intracranial artery calcification into two groups according to the duration of maintenance hemodialysis and compared the frequency of intracranial calcification of each of the intracranial arteries between the two groups. Intracranial artery calcification was found in 36 of the 50 hemodialysis patients. Among the 36 patients with intracranial artery calcification, the prevalence of calcification of each of the arteries was as follows: vertebral artery, 58.3%; internal carotid artery, 61.1%; basilar artery, 41.7%; anterior cerebral artery, 16.7%; middle cerebral artery, 30.6%; posterior cerebral artery, 8.3%. The prevalence of calcification of each of the intracranial arteries did not differ significantly between the patients with a hemodialysis duration of more than 20 years and those less than 20 years. The most frequently involved site of calcification was the internal carotid artery. The prevalence of calcification of the other intracranial arteries, particularly of the basilar artery, were relatively high. The prevalence of calcification of each of the intracranial arteries did not differ significantly between the patients with a hemodialysis duration of more than 20 years and less than 20 years.     

维持性血液透析患者外周血FGF-23水平与血管钙化相关性研究

目的:了解维持性血液透析患者的外周血成纤维细胞生长因子(FGF-23)水平和血管钙化情况,探讨两者的相关性。方法:收集90例维持性血液透析患者的临床资料,通过X线平片评价血管钙化情况,双抗体夹心ABC-ELISA法测定外周血FGF-23水平,Spearman相关分析血管钙化评分与FGF-23水平的相关性,多元Logistic回归分析血管钙化的危险因素。结果:血管钙化评分≥3分患者的外周血FGF-23水平显著高于钙化评分<3分患者,(98.21±13.55)VS(58.65±6.36)pg/ml,P<0.05。Spearman秩相关显示血FGF-23水平与血管中重度钙化存在相关(r=0.315),并且FGF-23水平越高,血管钙化程度越重(r=0.328),P<0.05。多元Logistic回归分析结果显示,FGF-23浓度是血液透析患者中小动脉钙化的独立危险因素。结论:维持性血液透析患者普遍存在的血管钙化与血浆FGF-23水平相关,FGF-23水平是除老龄、糖尿病、残余肾功能丧失等传统因素之外的血管钙化的相对危险因素。     

Association between osteopontin and intact parathyroid hormone in maintenance hemodialysis patients

Objective To explore possible associations between osteopontin(OPN) and intact parathyroid hormone(iPTH), to investigate effects of them on the progression of carotid artery calcification in patients receiving long-term hemodialysis. Methods Forty-eight maintenance hemodialysis (MHD) patients and 28 age- and sex-matched healthy volunteers were recruited. The concentration of OPN in peripheral blood was determined by enzyme linked immunosorbent assay (ELISA). Levels of iPTH and presence of plaques in the common carotid arteries were also measured. The demographics were recorded. Results Compared with controls, levels of OPN[(137.4±80.8)ng/L vs (31.6±6.7) ng/L, P＜0.01] and iPTH[(456.4±326.4) ng/L vs (66.9±19.3)ng/L, P＜0.01] were higher inMHD patients before hemodialysis, the numbers of calcific plaques in the common carotid arteries were increased in MHD patients (P＜0.01). There was a positive correlation between pre-dialysis OPN levels and iPTH levels (r＝0.620, P＜0.01) in MHD patients. Higher levels of OPN and iPTH correlated with greater numbers of calcific plaques in the common carotid arteries after division into three subgroups of MHD patients based on calcific plaques. In multiple linear regression analysis, the correlation between the pre-dialysis OPN and iPTH levels remained the same even if adjusting for confounding effects[β＝0.468, 95%CI (0.036, 0.195), t＝2.936, P＝0.005]. Conclusion OPN level is positively correlated with iPTH level in hemodialysis patients, which suggesting that both of them play important roles in the progression of carotid artery calcification.     

Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients

BACKGROUND: Cardiovascular event is the major cause of mortality in patients on maintenance hemodialysis. We prospectively tested the predictive values of atherosclerotic parameters for all-cause and cardiovascular outcomes in 219 hemodialysis patients (age, 58 +/- 13 years; time on hemodialysis, 13 +/- 7 years; male/female, 144/75). METHODS: We measured blood homocysteine (Hcy), ultrasound carotid artery intima media thickness (IMT) and % aortic wall calcification at L2/3 region [% of calcification index in the abdominal aortic wall (%ACI)] by computed tomography (CT) scan, and followed all patients for 5 years. RESULTS: During the follow-up periods, 54 patients (25%) died, 40 (74%) of them of cardiovascular causes. IMT was significantly higher in patients who expired (0.75 +/- 0.02 mm) than in those who survived (0.62 +/- 0.01 mm). IMT was significantly correlated with age (r = 0.47, P < 0.01) and %ACI (r = 0.27, P < 0.01). The survival rate during the observation was significantly lower in the final IMT third (58%) than in the first (90%) and the middle IMT third (80%) (P < 0.01). Multivariate Cox proportional hazards analysis revealed that diabetes and IMT became independent determinants of all-cause and cardiovascular death. Adjusted hazards ratios of all-cause and cardiovascular mortality for an increase of 0.1 mm in IMT were 1.31 (95% CI, 1.07 to 1.59) and 1.41 (95% CI, 1.12 to 1.76). In contrast, %ACI at abdominal aorta and blood Hcy did not affect their 5-year mortality. CONCLUSION: These findings suggested that measurement of carotid artery IMT is useful for predicting long-term mortality in patients receiving maintenance hemodialysis.     

血液透析者冠状动脉钙化的相关因素分析

目的：分析维持性血液透析患者冠状动脉钙化的相关因素。方法：采用菲利浦螺旋CT扫描以钙化积分确定冠状动脉钙化的程度,根据冠状动脉钙化程度对透析患者进行分组,回顾性分析比较各组临床资料,并进行生存率分析。结果：透析患者冠状动脉轻、中、重度钙化组与非钙化组存在年龄、透析龄、血胆固醇、血三酰甘油、血尿素氮、血肌酐、C反应蛋白的差异,钙化积分与年龄相关,与骨质疏松无关。冠脉钙化组患者3年的生存率低于无冠脉钙化组患者。结论：维持性血液透析患者冠状动脉钙化与年龄、透析龄、血脂代谢紊乱、微炎症、尿毒症毒素水平有关,与骨质疏松无关。冠脉钙化降低了患者的3年生存率。     

Calcification of the epididymis and the tunica albuginea of the corpora cavernosa in patients on maintenance hemodialysis

The aims of this study were to determine the incidence rates of genital calcification in male hemodialysis patients based on ultrasonography findings and to identify risk factors for this condition. Twenty-three male end-stage renal disease (ESRD) patients (mean age, 51.4 +/- 12.1 years) who were on maintenance hemodialysis underwent penile and scrotal ultrasonography. For each case, we recorded the underlying renal disease and measured serum levels of phosphorus, intact parathormone, and calcium x phosphorus product. Patients were also questioned about erectile dysfunction. The control group consisted of 22 consecutive patients (mean age, 51 years) with type 2 diabetes mellitus with normal renal function who underwent penile and scrotal ultrasonography for various reasons. In the ESRD group, ultrasound revealed calcification of the tunica albuginea of the corpora cavernosa in 15 patients (65%) and calcification of the epididymis in 16 patients (70%; 14 bilateral and 2 unilateral cases). Twenty patients (87%) showed calcification of the epididymis and/or the tunica, and 10 (43%) showed calcification of both these tissues. The rates of epididymal and penile calcification in the ESRD patients and the controls were significantly different (P <.001 for both). There were no significant differences between patients with and without penile and epididymal calcification with respect to age, hemodialysis duration, frequencies of elevated serum phosphorus, elevated serum intact parathormone, elevated calcium x phosphorus product, and frequency of erectile dysfunction (ED) (P >.05 for all). Ultrasonography revealed high rates of penile (tunica albuginea of the corpora cavernosa) and epididymal calcification (65% and 70%, respectively) in the ESRD patients studied, but no association was found between risk factors such as age, underlying renal disease, hemodialysis duration, frequencies of elevated serum phosphorus, elevated serum intact parathormone, and elevated calcium x phosphorus product.     

Treatment of hyperphosphatemia in patients with chronic kidney disease on maintenance hemodialysis

Treatment of hyperphosphatemia in patients with chronic kidney disease on maintenance hemodialysis. Hyperphosphatemia in patients with ESRD leads to secondary hyperparathyroidism, renal osteodystrophy, and is independently associated with mortality risk. The exact mechanism by which hyperphosphatemia increases mortality risk is unknown, but it may relate to enhanced cardiovascular calcification. National Kidney Foundation K/DOQI bone metabolism and disease guidelines recommend maintenance of serum phosphorus (P) below 5.5 mg/dL, and Ca x P product less than 55 mg(2)/dL(2). Although calcium-based phosphate binders (CBPB) are cost effective, long-term safety concerns relate to their postulated role in progression of cardiovascular calcification. Sevelamer hydrochloride has been recommended as an alternative noncalcium phosphate binder. Results from the Calcium Acetate Renagel Evaluation (CARE study) indicate that calcium acetate is more effective than sevelamer in controlling serum phosphorous and Ca x P product in hemodialysis patients. In the Treat-to-Goal study, dialysis patients treated with sevelamer had slower progression of coronary and aortic calcification than patients treated with CBPB. The mechanism underlying the beneficial effect of sevelamer is unknown, but may relate to decreased calcium loading or to dramatic reductions in LDL cholesterol in sevelamer-treated patients. At present, evidence incriminating CBPB in the progression of cardiovascular calcification in ESRD remains largely circumstantial. As calcium acetate is more efficacious and cost effective than sevelamer, it remains an accepted first-line phosphate binder. In this review, we will examine these issues and provide rational guidelines for the use of calcium-based phosphate binders in patients on maintenance hemodialysis.