Extraskeletale Verkalkungen bei der chronischen Niereninsuffizienz unter Dialysebehandlung und nach Nierentransplantation

Abstract

The frequency of calcifications in vessels and soft tissue was 39% in 184 patients with chronic renal failure. Non-dialyzed patients and dialyzed patients at the start of dialysis treatment had most frequently calcifications of the aorta and larger vessels. Renal transplant recipients, who developed osteonecrosis or spontaneous fractures after transplantation, showed at the time of transplantation a higher frequency of calcifications compared to renal transplant recipients, who did not develop these complications. The frequency of calcifications increased with increasing age not only in the aorta, but also in the other vessels. In nondialyzed patients and in dialyzed patients at the start of dialysis treatment the calcifications were more commonly found in women and in renal transplant recipients in men. In all groups of patients a significant, higher frequency of calcifications was found in patients with radiologic evidence of bone resorption compared to patients without resorptive bone changes. Before and during chronic hemodialysis and following renal transplantation the frequency of calcifications increased. Calcification was most pronounced in the larger vessels in nondialyzed and dialyzed patients and in small vessels in renal transplant recipients. Increase in frequency of calcifications occurred slowly in nondialyzed patients and in renal transplant recipients, whereas an accelerated increase occurred in the first 15 months of the dialysis period in hemodialyzed patients.

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

“…(3) The high prevalence of hypertension, hypertrigly ceridemia, hyperglycemia and hyperphosphatemia in hemodialyzed patients may thus account for the high prevalence of radiological vascular calcifications in this population (25-50%) [1,7,8,10], This prevalence is prob ably much higher than in the nonuremic patients al though we could not find a comparative study with an age-and sex-matched control group. The only controlled study based on histological findings is the study of Ibels et al [8], who found that 46% of the hemodialyzed pa tients exhibited calcinosis versus only 17% of age-and sex-matched nonuremic patients.…”

“…The causal relationship between high doses of C aC 03 and vascular calcifications was not obvious, however, since the incidence of vascular calcifications was not greater than in a control group taking lower doses of C aC 03, aluminium phosphate bin ders and la-hydroxylated vitamin D3 [6], and the role of other risk factors of vascular calcinosis was not taken into account. Surprisingly, these factors were the object of only a few studies [1,[7][8][9][10], These studies show that a few factors are common to atherosclerosis, such as the male sex [1], age [1,10] and duration of hypertension [7], Other factors are common to nonvascular soft-tissue calcification, as the increase in plasma calcium and plasma phosphate [7,10]. Conflicting data, however, do exist as regards the effect of lowering the plasma calcium phosphate product since disappearance of vascular calcifications was re ported after decreasing this product by AI(OH)3 and vitamin D [15] but not after decreasing it by parathyroi dectomy [5].…”