Determinants of progressive vascular calcification in haemodialysis patients

• Published in: Nephrology, dialysis, transplantation Vol. 19; no. 6; pp. 1489 - 1496
• Main Authors: Chertow, Glenn M., Raggi, Paolo, Chasan-Taber, Scott, Bommer, Juergen, Holzer, Herwig, Burke, Steven K.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.06.2004
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arteriosclerosis - epidemiology; Arteriosclerosis - etiology; Biological and medical sciences; Blood Vessels - pathology; Calcinosis - epidemiology; Calcinosis - etiology; calcium; Calcium - blood; Comorbidity; Disease Progression; Emergency and intensive care: renal failure. Dialysis management; Epoxy Compounds - pharmacology; ESRD; Female; Glomerulonephritis; haemodialysis; Humans; Intensive care medicine; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Parathyroid Hormone; Phosphates - blood; Polyamines; Polyethylenes - pharmacology; PTH; Renal Dialysis; Sevelamer; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tomography, X-Ray Computed; Kidney disease; Human; ESRD; Urinary system disease; Calcium; Hemodialysis; PTH; haemodialysis; Inorganic element; Extrarenal dialysis; Parathormone; Renal failure; Chelating agent; Calcification; Sevelamer
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfh125

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.