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Nephrol Dial Transplant (2002) 17: 229-232
© 2002 European Renal Association-European Dialysis and Transplant Association

Personal Opinion

Does calcium kill ESRD patients—the skeptic's perspective

Joseph A. Coladonato1, Lynda A. Szczech1, Eli A. Friedman2 and William F. Owen, Jr1,

1 Duke Institute of Renal Outcomes Research and Health Policy, Duke University Medical Center, Durham, NC and 2 Downstate Medical Center, Brooklyn, NY, USA

Keywords: calcium-containing phosphate binders; end-stage renal disease; vascular calcification

Recently, there has been intense interest in vascular calcification and the use of calcium-containing phosphate binders for patients with end-stage renal disease (ESRD). A multi-centre trial evaluating the role of calcium-containing phosphate binders vs non-calcium, non-aluminum-containing binders and the progression of coronary calcification by electron beam computerized tomography (EBCT) has been underway for approximately 1 year. The interim results support observational data that the administration of calcium salts is associated with progressive coronary calcification, in contrast to non-calcium containing binders [1].

Vascular calcification occurs at two pathologic sites: in the intima, where it is invariably associated with atherosclerosis, and in the tunica media, where it is relevant to loss of vascular elasticity and compliance [2]. Medial calcification, also known as Mönckeberg's sclerosis, is common and so may occur independently of atherosclerosis, thus implying different aetiological mechanisms from intimal calcification [2]. It has been posited . . . [Full Text of this Article]

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