NDT Advance Access originally published online on April 21, 2004
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Nephrol Dial Transplant (2004) 19: 1489-1496
Nephrol Dial Transplant Vol. 19 No. 6 © ERA-EDTA 2004; all rights reserved
Original Article
Determinants of progressive vascular calcification in haemodialysis patients
1Divisions of Nephrology, Moffitt-Long Hospitals and UCSF-Mt. Zion Medical Center, Department of Medicine, University of California San Francisco, San Francisco, 2Division of Cardiology, Department of Medicine, Tulane University, New Orleans, 3Pioneer BioDiligence, Amherst, Massachusetts, USA, 4Universitätsklinikum Heidelberg, Heidelberg, Germany, 5Universitätsklinikum Graz, Graz, Austria and 6Genzyme Drug Discovery and Development, Waltham, Massachusetts, USA
Correspondence and offprint requests to: Glenn M. Chertow, MD, MPH, University of California San Francisco, Department of Medicine Research, UCSF Laurel Heights Suite 430, 3333 California Street, San Francisco, CA 94118-1211, USA. Email: chertowg{at}medicine.ucsf.edu
Background. We determined recently that targeted treatment with calcium-based phosphate binders (calcium acetate and carbonate) led to progressive coronary artery and aortic calcification by electron beam tomography (EBT), while treatment with the non-calcium-containing phosphate binder, sevelamer, did not. Aside from the provision of calcium, we hypothesized that other factors might be related to the likelihood of progressive calcification in both or either treatment groups.
Methods. We explored potential determinants of progressive vascular calcification in 150 randomized study subjects who underwent EBT at baseline and at least once during follow-up (week 26 or 52).
Results. Among calcium-treated subjects, higher time-averaged concentrations of calcium, phosphorus and the calcium-phosphorus product were associated with more pronounced increases in EBT scores; no such associations were demonstrated in sevelamer-treated subjects. The relation between parathyroid hormone (PTH) and the progression of calcification was more complex. Lower PTH was associated with more extensive calcification in calcium-treated subjects, whereas higher PTH was associated with calcification in sevelamer-treated subjects. Serum albumin was inversely correlated with progression in aortic calcification. Sevelamer was associated with favourable effects on lipids, although the link between these effects and the observed attenuation in vascular calcification remains to be elucidated.
Conclusion. Calcium-based phosphate binders are associated with progressive coronary artery and aortic calcification, especially when mineral metabolism is not well controlled. Calcium may directly or indirectly (via PTH) adversely influence the balance of skeletal and extraskeletal calcification in haemodialysis patients.
Keywords: calcium; ESRD; haemodialysis; PTH; sevelamer
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