Cardiovascular Calcifications in Uremic Patients

Abstract

Abstract. Cardiovascular disease is the leading cause of mortality among patients with ESRD (chronic kidney disease stage 5). Left ventricular hypertrophy and arterial diseases are the two principal risk factors for cardiovascular mortality in hemodialysis patients. Epidemiologic studies show that damage to large conduit arteries contributes to morbidity and mortality in patients with chronic kidney disease. Atherosclerosis is primarily an intimal disease characterized by the presence of plaques and occlusive lesions. Although atherosclerosis is the most frequent underlying cause of cardiovascular disease in patients with ESRD, it represents only one form of structural response to metabolic and hemodynamic alterations that interfere with the process of aging. Arterial alterations in ESRD include nonocclusive arterial remodeling accompanying the growing hemodynamic burden and humoral abnormalities that are associated with chronic uremia. The consequences of these alterations are different from those attributed to atherosclerotic plaques and are characterized principally by hardening (stiffening) of arteries. Arteriosclerosis, characterized by stiffening of the aorta and large capacitative arteries, is a major determinant of left ventricular pressure overload and of abnormal coronary perfusion. Atherosclerosis and arteriosclerosis are frequently comorbid and characterized by a high degree of both intimal and medial calcifications in patients with ESRD. The extent of calcifications and the degree of arterial stiffening are independent predictors of mortality. Studies in patients with ESRD have shown that attenuation of arterial stiffness can have a favorable effect, associated with regression of left ventricular hypertrophy, on survival. Calciumfree, metal-free phosphate binders such as sevelamer can reduce calcification scores.

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

“…By contrast, AS evaluates VC in muscular (radial and digital) or predominantly muscular (iliac and femoral) arteries, which are more susceptible to the calcification of the media (14,27). Although age, diabetes, and phosphorus levels seemed to be common elements associated with both pathologic KS and AS, this study shows the different prognostic value of both indexes, which suggests that the location of calcification seems to have prognostic significance in patients not on dialysis (28). Although both indexes behaved as predictors of death and hospital admission in the unadjusted analysis, only the AS is confirmed as an independent predictor in the multivariate analysis.…”

Acute tumoral calcinosis due to severe hyperphosphatemia in a maintenance hemodialysis patient

“…Physiological examination has shown a reduction in the ankle brachial index in patients with vascular stenosis as compared with the exacerbation of the brachial ankle pulse wave velocity in patients with vascular sclerosis. Cardiovascular disease results from both types of calcifications [12]. The mortality rate among patients with CKD-MBD is 10-to 20-fold higher than that among healthy people [13].…”

Complications and Managements of Hyperphosphatemia in Dialysis

“…(Schwarz et al, 2000). Medial calcification has been shown to affect vascular elasticity and leads to increased arterial wall stiffness of large capacity, elastic-type arteries like the aorta and the common carotid artery, increased pulse pressure and decreased perfusion of coronary arteries during diastole (Blacher et al, 1998;London, 2003;Speer & Giachelli, 2004). Recent studies also demonstrated that elevated FGF23 levels were associated with arterial stiffness, increased left ventricular mass index and increased prevalence of left ventricular hypertrophy in patients with CKD (Hsu & Wu, 2009;Mirza et al, 2009;Gutierrez et al, 2009).…”