Evaluation of Vascular Calcinosis Risk Factors in Patients on Chronic Hemodialysis: Lack of Influence of Calcium Carbonate

Renaud, H; A, Atik; Hervé, M A; Morinière, P; Hocine, C.; Belbrik, S.; Fournier, A

doi:10.1159/000184864

Cited by 27 publications

(8 citation statements)

References 6 publications

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“…Since then, numerous, though not all, studies have shown a correlation between high serum phosphate and the incidence or rate of progression of large artery VC [13, 16, 39, 40, 41], of CUA [23, 26, 29, 30], and of CAC [5]. Hyperphosphataemia has recently been shown to be an independent predictor of death amongst haemodialysis patients [42, 43].…”

Section: Causes Of and Risk Factors For Vc In Esrdmentioning

confidence: 99%

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Vascular Calcification in Chronic Renal Failure

Tomson¹

2004

Nephron Clin Pract

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The prevalence and extent of vascular calcification (VC) increases rapidly with time on dialysis. There is increasing evidence that medial calcification of conduit arteries, without intimal disease, is associated with important abnormalities of vascular compliance and increased risk of cardiovascular death. Coronary artery calcification is also common in end-stage renal disease, but further research is required to determine how much of this calcification is in the form of calcified intimal atherosclerotic plaque and how much in the tunica media. Calcific uraemic arteriolopathy causes a syndrome of ischaemic necrosis of the skin and subcutaneous tissue and appears to be increasing in incidence. At all sites, arterial calcification is a biologically controlled process, with expression in vascular smooth muscle cells of genes usually expressed in osteoblasts and the formation of hydroxyapatite. High extracellular phosphate concentration induces these phenotypic changes in vitro, and much of the clinical evidence supports hyperphosphataemia as the major driver of VC. Whether warfarin treatment plays a role, by inhibiting production of vitamin-K-dependent inhibitors of calcification in humans, remains uncertain but possible. High doses of prescribed calcium-based phosphate binders are associated with VC, whereas use of sevelamer to achieve the same serum phosphate level greatly retards progression of coronary and aortic calcification. The biological mechanism by which positive calcium balance and/or episodes of hypercalcaemia promotes VC remains unclear. Treatment of established calcific uraemic arteriolopathy consists of aggressive reduction of serum calcium × phosphate product; the roles of hyperbaric oxygen, steroid therapy, and non-warfarin anticoagulation remain uncertain.

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Section: Causes Of and Risk Factors For Vc In Esrdmentioning

confidence: 99%

“…Progression of VC was related to hypertriglyceridaemia in a longitudinal study in France [40]. As discussed above, the beneficial effects of sevelamer on CAC [7]may have been due to its cholesterol-lowering effects.…”

Section: Causes Of and Risk Factors For Vc In Esrdmentioning

confidence: 99%

Vascular Calcification in Chronic Renal Failure

Tomson¹

2004

Nephron Clin Pract

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“…Hyperphosphataemia accompanying chronic renal failure is a major contributor to the development of renal osteodystrophy [1, 2, 3, 4]and soft-tissue calcification [5, 6, 7]. Accelerated vascular calcifications (coronary and valvular) are common in chronic dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Sevelamer in the Treatment of Uncontrolled Hyperphosphataemia of Haemodialysis Patients

Almirall

Lopez²,

Vallve³

et al. 2004

Nephron Clin Pract

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Background/Aim: The treatment of hyperphosphataemia is of major importance in the management of patients on dialysis. Traditional phosphate binders can be associated with undesirable effects. Recently, a new non-absorbable phosphate-binding polymer, sevelamer hydrochloride, has been available. Clinical information is scarce, and its cost could be a limiting factor for its wider use. No studies have evaluated its usefulness in uncontrolled hyperphosphataemic patients. Methods: We identified 34 patients with a maintained serum phosphorus concentration >6.5 mg/dl and/or toxicity related to standard phosphorus-binding treatment (aluminium or calcium based). Sevelamer was added and titrated up fortnightly to achieve phosphorus control. Previous phosphate binders were decreased, whenever possible. The period of the study was 6 months. Results: Thirteen patients (38%) dropped out because of side effects, mainly related to the gastro-intestinal tract. The efficacy analysis disclosed that the phosphorus concentration decreased from 2.39 ± 0.48 to 1.84 ± 0.48 mmol/l (p < 0.001). The mean dose of sevelamer was stabilised at 3.4 ± 1.8 g/day. The amount of calcium- and aluminium-based phosphate binders could be decreased from 5.1 ± 3.5 to 3.1 ± 2.7 g/day (38% decrease) and from 2.4 ± 1.5 to 1.5 ± 1.7 g/day (36% decrease), respectively. The Ca × P product was significantly decreased from 5.83 ± 1.19 to 4.36 ± 1.12 mmol/l² (p < 0.001). The total cholesterol concentration decreased from 4.34 ± 0.9 to 3.98 ± 0.9 mmol/l (p < 0.01) and the low-density lipoprotein cholesterol level from 2.61 ± 0.98 to 2.20 ± 0.77 mmol/l (p < 0.03). Conclusions: Sevelamer is an effective phosphate binder that allows a better serum phosphorus control, while allowing a decrease in the dose of calcium- and aluminium-based phosphate binders in these difficult patients. The drawbacks are the high intolerance rate and the price of the product.

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“…To determine cardiovascular morphological changes in ESRD patients, echocardiography, CT tomography and radiography have been used in many studies. Many investigations regard arterial calcification as a representative vascular alteration in ESRD patients [6, 7, 8, 9, 10]. However, it is difficult to thoroughly evaluate cardiovascular changes in living patients.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Fluctuation Pattern of Blood Pressure during Hemodialysis Treatment and Cardiovascular Morphology: An Autopsy Study of 53 Cases

Matsumae¹,

Matsumae²,

Hasegawa

et al. 2001

Nephron

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Background: Cardiovascular morphological changes are often conspicuous in autopsy examination of chronic hemodialysis (HD) patients. On the other hand, the fluctuation pattern in blood pressure (BP) during HD treatment varies from one patient to another. Cardiovascular changes may correlate with clinical findings including BP fluctuation patterns during HD, although no autopsy studies have previously examined this issue. Methods: In this study, 53 autopsies of patients who had been on chronic HD were reviewed. We determined the relationship between BP fluctuation during HD treatment along with stable and cardiovascular morphology, including heart weight, ventricular wall thickness, circumferences of the valves and the severity of aortic arteriosclerosis and coronary stenosis. Patients were divided into 4 groups according to the pattern of BP fluctuation during HD treatment at about 6 months before death: group 1 (n = 13), symptomatic hypotension and/or decline pattern during HD; group 2 (n = 11), continuously high BP during HD treatment; group 3 (n = 17), continuous normal BP during HD treatment, and group 4 (n = 12), continuously low BP without symptomatic hypotension during HD treatment. Results: Heart weight and ventricular wall thickness were greatest in group 2. The scores for aortic arteriosclerosis in groups 1 and 2 were higher than in groups 3 and 4. The coronary stenosis index was significantly higher in group 1 than in the other groups, and that in group 2 was higher than in group 4. Multiple regression analysis showed that age, HD duration and pulse pressure were independent variables for the score of arteriosclerosis, and the decline pattern of BP fluctuation during HD and pulse pressure were independent variables for coronary stenosis index. Conclusions: Our results suggest that certain clinical parameters including BP during HD may reflect cardiovascular morphological changes in stable HD patients, although further examination, such as 24-hour blood pressure measurement is recommended to elucidate the pathophysiology of cardiovascular diseases in HD patients.

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Evaluation of Vascular Calcinosis Risk Factors in Patients on Chronic Hemodialysis: Lack of Influence of Calcium Carbonate

Cited by 27 publications

References 6 publications

Vascular Calcification in Chronic Renal Failure

Vascular Calcification in Chronic Renal Failure

Safety and Efficacy of Sevelamer in the Treatment of Uncontrolled Hyperphosphataemia of Haemodialysis Patients

Relationship between Fluctuation Pattern of Blood Pressure during Hemodialysis Treatment and Cardiovascular Morphology: An Autopsy Study of 53 Cases

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