ReviewDisordered Mineral Metabolism and Vascular Calcification in Nondialyzed Chronic Kidney Disease Patients
Section snippets
Is There Disordered Mineral Metabolism in Nondialyzed Patients With CKD
In the care of patients with CKD, disordered mineral metabolism is monitored by the measurement of serum levels of divalent ions such as Ca and P and hormones like PTH.1, 2 Not too long ago, the serum levels of markers of disordered mineral metabolism were viewed largely as surrogates for bone turnover and health, and the acceptable range for each of these parameters was defined as one that was expected to result in the normalization of bone metabolism.1 However, recent studies have
Vascular Calcification in Nondialyzed Patients With CKD
Under normal circumstances, there is usually no detectable calcification in the blood vessel walls. In pathologic states, calcification can occur in either the intima or the media of the vessel walls, and the term VC is used to refer to either of the 2 clinical entities. The process of vascular calcification, whether intimal or medial, is an active process akin to ossification of the bones.22, 24, 103 Under a variety of stimuli, calcifying vascular cells change from a mesenchymal to an
Is the Vascular Calcification in Nondialyzed Patients With CKD a Consequence of Disordered Mineral Metabolism?
A relationship between mineral metabolism and VC has long been sought in many populations, including but not limited to CKD. In the general population, investigators have been unable to show any relationship between serum Ca, P, and PTH with the severity of VC.122, 131 Some studies, although not all, have shown an inverse relationship between circulating serum 1,25 dihydroxy vitamin D levels and the severity of coronary artery calcification.131, 132, 133 On the other hand, there is a large body
Conclusions
The process of VC begins in early CKD, particularly among the elderly and those with type 2 diabetes. Although the calcification burden is less severe than among patients with ESRD, it is significantly more severe than in age- and gender-matched controls. Furthermore, calcium begets calcium, and among individuals with diabetic nephropathy, the coronary artery calcification burden is an important predictor of future progression, including after the appearance of ESRD. Thus, this early
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Supported by a grant from the National Center for Research Resources (NCRR, NIH), RR18298-01 A1 for Rajnish Mehrotra and grant M01-RR00425 from the NCRR, NIH, for the General Clinical Research Center (GCRC) located at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. Additional support has been provided by Clinical Research Feasibility Funds from the GCRC at Harbor-UCLA and Genzyme Pharmaceuticals.