Cardiac valve calcification in haemodialysis patients: role of calcium-phosphate metabolism

Ribeiro, Silvia Carreira; Ramos, Aura; Brandão, Alice; Rebelo, Joyce; Guerra, Amanda Carolina Damasceno Zanuto; Resina, Cristina; Vila-Lobos, A; Carvalho, Fabyola Barros de; Remedio, F.; Ribeiro, Francilene Alves

doi:10.1093/ndt/13.8.2037

Cited by 306 publications

(225 citation statements)

References 7 publications

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“…Inflammatory molecules, modified lipids, infectious agents, and circulating levels of calcium and phosphate have been proposed as potential promoters of valve calcification. 1,6,7 However, little is known about the effects of these factors on the calcifying behavior of aortic valve interstitial cell (VIC) subpopulations. We and others have previously shown in the porcine and human system that VIC represent a phenotypically heterogeneous population of cells mainly composed by fibroblasts/myofibroblasts/smooth muscle (SM) cells.…”

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confidence: 99%

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Clones of Interstitial Cells From Bovine Aortic Valve Exhibit Different Calcifying Potential When Exposed to Endotoxin and Phosphate

Rattazzi

Iop

Faggin

et al. 2008

ATVB

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“…7 Increased level of serum phosphate which typically occurs in these patients is now considered relevant for the progression of vascular calcification. Seminal work by Giachelli's group demonstrated that phosphate could induce a phenotypic switch of SM cells toward an osteoblast/chondrocyte profile and promote calcium deposition in vitro.…”

mentioning

confidence: 99%

Clones of Interstitial Cells From Bovine Aortic Valve Exhibit Different Calcifying Potential When Exposed to Endotoxin and Phosphate

Rattazzi

Iop

Faggin

et al. 2008

ATVB

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“…The administration of such compounds, however, contributes to the development of frequent episodes of hypercalcemia, hyperphosphatemia, adynamic osteodystrophy, and vascular calcifications (2)(3)(4)(5)(6)(7)(8). Indeed, current evidence indicates that abnormalities in mineral metabolism, as well as the therapeutic agents that are most widely used for the treatment of 2°HPT, play a role in the development of vascular calcifications in adult and pediatric patients with ESRD (2,4,5) and may contribute to decreased overall survival in ESRD (9 -11).…”

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Sevelamer Controls Parathyroid Hormone–Induced Bone Disease as Efficiently as Calcium Carbonate without Increasing Serum Calcium Levels during Therapy with Active Vitamin D Sterols

Salusky¹,

Goodman²,

Sahney³

et al. 2005

Journal of the American Society of Nephrology

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Little is known about the impact of various phosphate binders on the skeletal lesions of secondary hyperparathyroidism (2°HPT). The effects of calcium carbonate (CaCO 3 ) and sevelamer were compared in pediatric peritoneal dialysis patients with bone biopsy-proven 2°HPT. Twenty-nine patients were randomly assigned to CaCO 3 (n ‫؍‬ 14) or sevelamer (n ‫؍‬ 15), concomitant with either intermittent doses of oral calcitriol or doxercalciferol for 8 mo, when bone biopsies were repeated. Serum phosphorus, calcium, parathyroid hormone (PTH), and alkaline phosphatase were measured monthly. The skeletal lesions of 2°HPT improved with both binders, and bone formation rates reached the normal range in approximately 75% of the patients. Overall, serum phosphorus levels were 5.5 ؎ 0.1 and 5.6 ؎ 0.3 mg/dl (NS) with CaCO 3 and sevelamer, respectively. Serum calcium levels and the Ca ؋ P ion product increased with CaCO 3 ; in contrast, values remained unchanged with sevelamer (9.6 ؎ 01 versus 8.9 ؎ 0.2 mg/dl; P < 0.001, respectively). Hypercalcemic episodes (>10.2 mg/dl) occurred more frequently with CaCO 3 (P < 0.01). Baseline PTH levels were 980 ؎ 112 and 975 ؎ 174 pg/ml (NS); these values decreased to 369 ؎ 92 (P < 0.01) and 562 ؎ 164 pg/ml (P < 0.01) in the CaCO 3 and the sevelamer groups, respectively (NS between groups). Serum alkaline phosphatase levels also diminished in both groups (P < 0.01). Thus, treatment with either CaCO 3 or sevelamer resulted in equivalent control of the biochemical and skeletal lesions of 2°HPT. Sevelamer, however, maintained serum calcium concentrations closer to the lower end of the normal physiologic range, thereby increasing the safety of treatment with active vitamin D sterols.

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“…[1,2] Excess phosphorus combines with calcium and deposits in arteries and other soft tissues and leads to the development of atherosclerotic heart disease. [3] Elevated serum phosphorus also stimulates parathyroid hormone and contributes to secondary hyperparathyroidism and renal bone disease. [1,4,5] The amount of phosphorus in the American diet has increased considerably, primarily from phosphorus containing additives in convenience and fast foods.…”

Section: Introductionmentioning

confidence: 99%

Phosphorus-Containing Food Additives and the Accuracy of Nutrient Databases: Implications for Renal Patients

Sullivan

León

Sehgal

2007

Journal of Renal Nutrition

148

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Objective-Phosphorus containing additives are increasingly added to food products. We sought to determine the potential impact of these additives. We focused on chicken products as an example.Methods-We purchased a variety of chicken products, prepared them according to package directions, and performed laboratory analyses to determine their actual phosphorus content. We used ESHA Food Processor SQL Software to determine the expected phosphorus content of each product.Results-Of 38 chicken products, 35 (92%) had phosphorus containing additives listed among their ingredients. For every category of chicken products containing additives, the actual phosphorus content was greater than the content expected from nutrient database. For example, actual phosphorus content exceeded expected phosphorus content by an average of 84 mg/100g for breaded breast strips. There was also a great deal of variation within each category. For example, the difference between actual and expected phosphorus content ranged from 59 to 165 mg/100g for breast patties. Two 100 g servings of additive containing products contain an average of 440 mg of phosphorus, or about half the total daily recommended intake for dialysis patients.Conclusion-Phosphorus containing additives significantly increase the amount of phosphorus in chicken products. Available nutrient databases do not reflect this higher phosphorus content, and the variation between similar products makes it impossible for patients and dietitians to accurately estimate phosphorus content. We recommend that dialysis patients limit their intake of additive containing products and that the phosphorus content of food products be included on nutrition facts labels.

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Cardiac valve calcification in haemodialysis patients: role of calcium-phosphate metabolism

Cited by 306 publications

References 7 publications

Clones of Interstitial Cells From Bovine Aortic Valve Exhibit Different Calcifying Potential When Exposed to Endotoxin and Phosphate

Clones of Interstitial Cells From Bovine Aortic Valve Exhibit Different Calcifying Potential When Exposed to Endotoxin and Phosphate

Sevelamer Controls Parathyroid Hormone–Induced Bone Disease as Efficiently as Calcium Carbonate without Increasing Serum Calcium Levels during Therapy with Active Vitamin D Sterols

Phosphorus-Containing Food Additives and the Accuracy of Nutrient Databases: Implications for Renal Patients

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