Coronary-Artery Calcification in Young Adults with End-Stage Renal Disease Who Are Undergoing Dialysis

Goodman, William G.; Goldin, Jonathan G.; Kuizon, Beatriz D.; Yoon, Chun; Gales, Barbara; Sider, Donna; Wang, Yan; Chung, Joanie; Emerick, Aletha; Greaser, Lloyd E.; Elashoff, Robert M.; Salusky, Isidro B.

doi:10.1056/nejm200005183422003

Cited by 2,406 publications

(1,958 citation statements)

References 29 publications

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“…It is likely that dietary phosphorus intake does affect serum phosphorus in MHD patients, but perhaps this relationship would only be strong when the serum phosphorus concentrations are time averaged throughout the day, or possibly even over the course of the week. Nonetheless, our data are in agreement with epidemiologic studies relating hyperphosphatemia to increased mortality in CKD (5-9,12,49,50) and maintenance dialysis patients (51,52).…”

Section: Discussionsupporting

confidence: 91%

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Noori¹,

Kalantar-Zadeh²,

Kövesdy³

et al. 2010

Clinical Journal of the American Society of Nephrology

194

125

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Background and objectives: Epidemiologic studies show an association between higher predialysis serum phosphorus and increased death risk in maintenance hemodialysis (MHD) patients. The hypothesis that higher dietary phosphorus intake and higher phosphorus content per gram of dietary protein intake are each associated with increased mortality in MHD patients was examined.Design, setting, participants, & measurements: Food frequency questionnaires were used to conduct a cohort study to examine the survival predictability of dietary phosphorus and the ratio of phosphorus to protein intake. At the start of the cohort, Cox proportional hazard regression was used in 224 MHD patients, who were followed for up to 5 years (2001 to 2006).Results: Both higher dietary phosphorus intake and a higher dietary phosphorus to protein ratio were associated with significantly increased death hazard ratios (HR) in the unadjusted models and after incremental adjustments for case-mix, diet, serum phosphorus, malnutrition-inflammation complex syndrome, and inflammatory markers. The HR of the highest (compared with lowest) dietary phosphorus intake tertile in the fully adjusted model was 2.37. Across categories of dietary phosphorus to protein ratios of <12, 12 to <14, 14 to <16, and >16 mg/g, death HRs were 1.13, 1.00 (reference value), 1.80, and 1.99, respectively. Cubic spline models of the survival analyses showed similar incremental associations.Conclusions: Higher dietary phosphorus intake and higher dietary phosphorus to protein ratios are each associated with increased death risk in MHD patients, even after adjustments for serum phosphorus, phosphate binders and their types, and dietary protein, energy, and potassium intakes.

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Section: Discussionsupporting

confidence: 91%

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Noori¹,

Kalantar-Zadeh²,

Kövesdy³

et al. 2010

Clinical Journal of the American Society of Nephrology

194

125

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“…(45)(46)(47)(48)(49) However, high calcium intakes have been associated with ischemic brain lesions on MRI (50) and with vascular calcification in populations with renal failure. (7,51,52) Our finding of decreased AAC in the highest quartile of dietary calcium intake is consistent with the epidemiologic studies. The findings that calcium supplements may increase the risk of cardiovascular events (10) and that dietary calcium does not appear related to vascular events suggest that calcium supplements and dietary calcium intake have different biologic effects.…”

Section: Discussionsupporting

confidence: 90%

“…(5,6) In patients with renal failure, calcium supplements accelerate vascular calcification and increase mortality in both dialysis and predialysis populations. (7)(8)(9) Calcium supplements also have been associated with increased cardiovascular event rates in a randomized, controlled trial in older women (10) and subsequent meta-analysis. (11) The mechanism of the association between calcium metabolism and vascular disease is unknown.…”

Section: Introductionmentioning

confidence: 99%

Relationships between vascular calcification, calcium metabolism, bone density, and fractures

Wang

Bolland

Pelt

et al. 2010

Journal of Bone and Mineral Research

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Factors involved with calcium metabolism, such as serum calcium and phosphate and calcium intake, have been associated with vascular disease in different populations. We investigated whether this association is mediated via increased vascular calcification by assessing relationships between these factors and abdominal aortic calcification (AAC) and coronary artery calcification (CAC). A total of 1471 healthy postmenopausal women participated in a 5-year randomized, placebo-controlled trial of calcium 1 g/day, and 323 healthy middle-aged and older men participated in a 2-year randomized, placebo-controlled trial of calcium 600 or 1200 mg/day. AAC was assessed on vertebral morphometric images at baseline and follow-up. Based on computed tomography, 163 men had CAC assessed, on average, 1.5 years after study completion. In elderly women, AAC was positively related to serum calcium (p < .001), phosphate (p ¼ .04), and the calcium-phosphate product (p ¼ .003), but changes in AAC over time and incidence of cardiovascular events were not related to these variables. In middle-aged men, AAC and CAC were not consistently related to these variables. Neither dietary calcium intake nor calcium supplementation was associated with changes in the prevalence of AAC over time, and calcium supplementation also was not related to CAC scores in men. After adjusting for age, AAC was not associated with low bone mineral density (BMD) at baseline, changes in BMD over time, or fracture incidence. CAC also was not related to baseline BMD. In summary, serum calcium and phosphate are associated with AAC in older women, but dietary calcium intake and calcium supplementation were not associated with changes in AAC over 2 to 5 years. ß

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“…Coronary plaques in patients with ESRD exhibit extensive heterotopic calcification 16. On computed tomography coronary angiography in young patients with ESRD, a disproportionate incidence of high calcium scores is detected with the probability of coronary artery calcification increasing with longer durations of dialysis 16.…”

Section: Cad In Patients With Esrdmentioning

confidence: 99%

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Bhatti

Galougahi

Paz

et al. 2016

JAHA

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Coronary-Artery Calcification in Young Adults with End-Stage Renal Disease Who Are Undergoing Dialysis

Abstract: Coronary-artery calcification is common and progressive in young adults with end-stage renal disease who are undergoing dialysis.

Cited by 2,406 publications

References 29 publications

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Relationships between vascular calcification, calcium metabolism, bone density, and fractures

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

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