终末期肾脏病透析患者骨密度与冠脉钙化的相关性分析

目的探讨终末期肾脏病(end stage renal disease,ESRD)透析患者骨密度与冠状动脉钙化(coronary artery colcification,CAC)之间的相关性。方法本研究为横断面研究。纳入115例ESRD患者,收集相关人口学特征、原发病、实验室检查等资料,双能X射线评估腰椎、股骨颈及髋部骨密度,多层螺旋计算机断层扫描(MSCT)检查患者CAC发生情况。以钙化积分100为界,将患者分为高钙化组和低钙化组。结果高钙化组56例,占维持性透析患者48%,其中男性36例,占高钙化组人数64.3%。高钙化组年龄、透析龄及血清甲状旁腺激素、碱性磷酸酶、25(OH) D水平均明显高于低钙化组,而股骨颈骨密度、髋部骨密度、血清胆固醇水平明显低于低钙化组(P0.05);男性高钙化组股骨颈骨密度及髋部骨密度明显低于低钙化组,且其冠脉钙化积分与股骨颈骨密度(r=-0.34,P0.05)、髋部骨密度(r=-0.65,P0.01)呈负相关。多元线性回归分析校正了年龄、透析龄等因素后仍显示男性髋部骨密度与冠脉钙化积分呈负相关(β=-1870.47,P0.05)。但在女性患者中,高钙化组与低钙化组骨密度无明显差异。结论骨密度降低可能是男性维持性透析患者冠脉钙化风险增高的危险因素。     

尿毒症患者血管中膜钙化和骨特异性蛋白的表达

目的研究尿毒症患者血管中骨特异性蛋白的表达和钙盐沉积的关系。方法88例尿毒症患者在接受肾移植手术时，留取其腹壁下动脉的近端2～3cm。钙盐沉积染色采用von Kossa法和茜素红染色方法。骨特异性蛋白，包括骨桥蛋白(OPN)、骨唾液酸桥蛋白(BSP)及碱性磷酸酶(AKP)的表达采用免疫组化染色法。测定血钙、磷、FrrH、甘油三酯(TG)、总胆固醇(Tch)、低密度脂蛋白(LDL)，计算体重指数(BMI)。结果88例腹壁下动脉标本中出现血管钙化的有23例，发生率为26．1％；轻中度钙化8例(9．1％)，重度钙化15例(17％)，均发生在血管中膜。出现明显钙化的腹壁下动脉的中膜均有OPN、BSP、AKP的阳性沉积；65例无明显钙化的标本中也有50例(76．9％)中膜有AKP、OPN、BSP的阳性沉积。腹壁下动脉重度钙化标本中膜OPN、BSP、AKP免疫组化的积分均显著高于无钙化标本，轻中度钙化标本AKP的积分也高于无钙化标本。年龄、BMI与OPN、AKP、BSP免疫组化阳性积分均成正相关，血磷与OPN(r=0．262，P=0．017)，AKP(r=0．23，P=0．036)成正相关。结论尿毒症患者腹壁下动脉的钙化与骨特异性蛋白的表达有关。在一些无显性钙化的患者腹壁下动脉也有骨特异性蛋白的表达，提示血管骨特异性蛋白的表达可能是血管壁钙化的早期表现．细胞介导的主动钙化过程参与了尿毒症患者血管中膜的钙化。     

Evaluation and treatment of coronary artery disease in patients with end-stage renal disease

Evaluation and treatment of coronary artery disease in patients with end-stage renal disease. Patients with end-stage renal disease (ESRD) are at increased risk of death from coronary artery disease (CAD). The metabolic milieu that results from renal dysfunction appears to accelerate the atherosclerotic process by decades in patients with ESRD. The extremely high prevalence of atherosclerosis in patients with ESRD mandates risk factor identification and treatment. Traditionally, CAD in this patient population has been treated conservatively. Analysis of large databases has highlighted the scope and complexity of this problem; nonetheless, there is a paucity of randomized, controlled trials of CAD in patients with ESRD. In this paper the following issues related to evaluation and treatment of patients with chronic kidney disease are addressed: (1) optimal CAD risk management; (2) evaluation for CAD in patients with ESRD, including the identification of coronary calcification; (3) treatment of CAD with medical therapy and revascularization; (4) relative merits of percutaneous coronary intervention versus bypass surgery. In general, an aggressive approach to medical management of CAD is warranted, even in the setting of subclinical CAD. A low threshold for diagnostic testing should be employed in patients with ESRD. When significant CAD is identified, ESRD patients appear to benefit more from revascularization compared to conservative medical management. Thus, if clinically reasonable, patients with ESRD and CAD should be managed aggressively to improve survival and reduce the incidence of future cardiac events.     

Human trabecular bone microarchitecture can be assessed independently of density with second generation HR-pQCT

The second generation HR-pQCT scanner (XtremeCTII, Scanco Medical) can assess human bone microarchitecture of peripheral limbs with a 61 μm nominal isotropic voxel size. This is a marked improvement from the first generation HR-pQCT that had a nominal isotropic voxel size of 82 μm, which is at the limit to accurately determine the thickness of individual human trabeculae. We sought to determine the accuracy of a direct morphometric approach to measure trabecular bone microarchitecture with three-dimensional morphological techniques using second generation HR-pQCT, and to compare this with the approach currently applied by the first generation HR-pQCT scanner based on derived indices using ex vivo scans of human cadaveric radii. We also compared images acquired and resampled to mimic the first generation HR-pQCT with those obtained directly from the first generation HR-pQCT.We evaluated 20 human cadaveric radii and a micro-CT performance phantom using the first (XtremeCT, Scanco Medical) and second generation HR-pQCT scanner (XtremeCTII) and compared a patient evaluation (XCTII, 61 μm) with a high resolution ex vivo protocol (HR, 30 μm). We generated 82 μm scans of the same specimens to mimic a first-generation HR-pQCT evaluation (XCTIM, 82 μm) and compared these with a first-generation patient evaluation (XCTI, 82 μm). A standard structural extraction approach was applied to both XCTII and HR evaluations for assessment of bone volume fraction (BV/TV), and a distance transform was used to assess trabecular number (Tb.N), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp). For XCTI and XCTIM evaluations we followed the manufacturer's standard procedure and assessed bone mineral density (BMD), Tb.N with a distance transform, and then derived bone volume ratio (BV/TV^d), trabecular thickness (Tb.Th^d) and separation (Tb.Sp^d).The spatial resolution (10% MTF) was 142.2 μm for XCTI, 108.9 μm for XCTIM, 95.2 μm for XCTII, and 55.9 μm for HR. XCTI and XCTIM provided strongly associated measurements of BMD and microarchitectural outcomes (R² > 0.97), however there were systematic differences in all outcomes. The Tb.N was highly associated with HR by both XCTII (R² = 0.93, mean error = − 0.12 mm^− 1) and XCTIM (R² = 0.98, mean error = 0.25 mm^− 1). Also, both XCTII (R² = 0.99, mean error = 0.20 mm) and XCTIM (R² = 0.99, mean error = − 0.18 mm) had Tb.Sp that were strongly related to HR. For Tb.Th, the XCTII was more closely related to HR (R² = 0.94, mean error = 0.04 mm) than the relatively weak XCTIM (R² = 0.16, mean error = − 0.076 mm).We found that trabecular microarchitecture assessment following the XCTII direct morphometric approach accurately represented the HR data. In particular, the measure of Tb.Th was markedly improved for XCTII compared with the derived approach of XCTIM. These data support the application of analysis techniques in HR-pQCT that are analogous to those traditionally used for micro-CT to assess trabecular microarchitecture. The decreased dependence of structural outcomes on density provides a new, important opportunity to monitor human in vivo bone microarchitecture.     

Angiographic progression of coronary artery disease in patients with end-stage renal disease.

BACKGROUND: Patients with end-stage renal disease have an increased risk of developing coronary artery disease (CAD). The cardiovascular mortality of dialysis patients is 10-15 times higher compared with the general population. The aim of our study was to evaluate the morphological progression of coronary arteriosclerosis in this cardiovascular high-risk group by visual assessment and quantitative coronary angiography. Methods and results. In 26 patients with chronic renal failure (age, 47+/-11 years; 15 male; duration of dialysis, 23+/-25 months) the severity of CAD and degree of coronary stenoses were assessed in two coronary angiograms after a mean follow-up interval of 30+/-15 months (12-60). Baseline angiography revealed CAD in 13/22 patients (59%). The second angiography was performed as screening procedure prior to renal transplantation (n=20) and/or as follow-up angiography after coronary angioplasty (n=10). Visual assessment showed a progression defined by the development of haemodynamically relevant stenosis of >50% luminal diameter in 13 patients. Quantitative angiographic evaluation was performed in a total of 45 segments showing >25% narrowing at the second angiogram. A progression (>15% luminal reduction) was found in 17 of 45 segments, a new lesion (initial luminal diameter <20%) was detected in nine segments, resulting in progression or new lesion in 16 patients (62%). Patients with or without progression did not differ in age, duration of dialysis treatment, number of cardiovascular risk factors, or serum total cholesterol and fibrinogen levels. After percutaneous transluminal coronary angioplasty (PTCA) a restenosis was seen in seven of 16 primarily successfully dilated segments. After the second angiography, myocardial revascularization was performed in eight patients (1 PTCA, 7 coronary artery bypass graft). CONCLUSIONS: Patients with end-stage renal disease have a high prevalence of CAD. In line with the clinical course, CAD patients on maintenance dialysis undergo rapid angiographic progression of CAD, which results in a high rate of subsequent myocardial revascularizations.     

Early coronary calcification in children and young adults with end-stage renal disease

Cardiovascular disease is a major cause of morbidity and mortality in children and young adults with end-stage renal disease. In our study, we retrospectively analyzed the records of 11 patients who had undergone electron beam computerized tomography in our dialysis unit. Our patients, aged 11 to 24 years (median, 19.3 years) were on dialysis or had functioning grafts. Coronary calcification was observed in seven patients (64%) with a mean calcium score of 273.8 +/- 708 (range 0.8 to 1864) in our study population. We compared clinical characteristics like age, gender, duration of end-stage renal disease, time on hemodialysis, body mass index, and blood pressures between the patients with calcifications (group I) and those with out calcification (group II). We also compared the laboratory data including daily calcium and calcitriol intake, lipid profile, serum calcium and phosphorus levels, calcium/phosphorus products, and serum parathyroid hormone levels in the both groups. The mean daily dose of total calcium, triglyceride level, and calcium/phosphorus products were higher in the calcification group though not statistically significant. The mean daily dose of calcitriol was significantly higher in patients with calcification. Using Spearman multivariate correlation, we found a correlation between the coronary calcium scores and mean daily doses of total calcium and calcitriol (r = .750, P =.008 and r = .869, P = .001, respectively). We conclude that coronary calcification, which is a proven predictor of cardiovascular disease, begins at a very early age and that daily doses of elemental calcium and calcitriol seem to be important factors in our study population.     

Soft tissue calcification in pediatric patients with end-stage renal disease

Soft tissue calcification is a recognized complication of uremia in adult patients and has been implicated as a cause of ischemic necrosis, cardiac arrhythmias, and respiratory failure. However, soft tissue calcification has been regarded as rare in pediatric renal patients. Following a sudden death due to pulmonary calcinosis in an adolescent after renal transplantation, we retrospectively reviewed clinical, biochemical and autopsy data of 120 patients with uremia, on dialysis, or following renal transplantation cared for at Childrens Hospital of Los Angeles from 1960 to 1983. Soft tissue calcification was found in 72 of 120 patients (60 percent). Forty-three patients (36 percent) had systemic calcinosis (Group A): the most frequent sites of mineral deposition were blood vessels, lung, kidney, myocardium, coronary artery, central nervous system, and gastric mucosa. Vascular calcification was uniformly accompanied by deposits in other organs. Twenty-nine patients had small amounts of focal calcification (Group B) and 48 patients had no soft tissue calcification (Group C). By multiple logistic regression analysis, the use of vitamin D or its analogues, the form of vitamin D medication prescribed, the peak calcium x phosphorus product, the age at onset of renal failure, and male sex were jointly associated with calcinosis (Group A). Vitamin D therapy showed the strongest independent association with calcinosis and the probability of calcinosis was greater in patients receiving calcitriol when compared with dihydrotachysterol and vitamin D2 or D3. The duration of renal failure, peak serum calcium, serum calcium at death, serum phosphorus at death, and primary renal diagnosis, were not statistically associated with calcinosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diagnostic tools and management strategies for coronary artery disease in patients with end-stage renal disease

Patients with renal disease often have coexistent coronary artery disease (CAD). The 5-year survival rates are < 50% and cardiovascular disease accounts for nearly half of the deaths in patients with end-stage renal disease (ESRD) on maintenance dialysis. Renal disease is often caused by hypertension or diabetes mellitus, both very strong risk factors for the development of CAD. Other patients develop hypertension after the onset of their renal disease. These coexistent diseases partially contribute to the increased incidence of CAD in the renal patient. Managing physicians must maintain a high index of suspicion and interpret the results of diagnostic studies with this high pretest probability in mind. Consideration should be given for screening for the presence of ischemic heart disease in patients with ESRD and no symptoms, especially if being considered as renal transplant recipients. It remains most important to adequately treat the associated risk factors and specifically, aggressively control the blood pressure. This report discusses the known and suspected reasons for the highly associated coexistent CAD, methods for diagnosing and risk-stratifying CAD, and renal-specific guidelines for appropriate treatment.     

Management of coronary artery disease in end-stage renal disease

Despite a substantial number of patients with end-stage renal disease who have coronary artery disease, the comparative effectiveness of revascularization procedures such as coronary artery bypass grafting and percutaneous coronary intervention remain unclear. Innovations in the field of coronary artery revascularization and concomitant changes in the standard of practice have improved outcomes in general. However, meaningful clinical decision-making remains difficult because it requires clinicians to extrapolate evidence derived from studies in the general population to patients with kidney disease for whom there is limited information from intervention trials. In non-randomized studies, this high-risk population for cardiovascular morbidity and mortality appear to derive substantial benefits from coronary revascularization. However, specific treatment decisions are often made based upon individual circumstances and contexts that are not well captured in these studies. This article reviews the available evidence, and its limitations, for deciding between various revascularization strategies for patients with end-stage renal disease. Several considerations that arise while making such decisions are discussed.     

Off-pump coronary artery bypass grafting in patients with end-stage renal disease on hemodialysis

BACKGROUND: Coronary artery bypass grafting (CABG) for hemodialysis patients is high risk compared with other patient groups. The aim of this study was to analyze the potential benefits of off-pump CABG for hemodialysis patients. METHODS: From April 1994 through December 2000, 26 hemodialysis patients underwent CABG. The off-pump group consisted of 15 patients operated on without a pump and the on-pump group consisted of 11 patients operated on with a pump. RESULTS: There was no difference between the two groups with regard to mean age, mean number of diseased vessels and mean number of anastomoses per patient. No patient died in either group during hospitalization. The postoperative complication rate was low in both groups. The postoperative ventilation time was shorter in the off-pump group (8.5 vs 26.1 hours, p < 0.001, respectively [off-pump group vs on-pump group]). The length of ICU stay was shorter in the off-pump group (1.7 vs 3.5 days, p = 0.01, respectively [off-pump group vs on-pump group]). The medial cost was lower in the off-pump group (26,200.80 dollars versus 44,024.10 dollars p = 0.0001 respectively [off-pump group vs on-pump group]). CONCLUSIONS: Off-pump CABG provided excellent less-invasive cardiac surgical results for dialysis patients.     

甲状旁腺切除术对终末期肾脏疾病患者冠状动脉钙化的影响

目的 评价甲状旁腺切除术(PTX)对终末期肾脏疾病(ESRD)患者冠状动脉钙化(CAC)的影响.方法 收集2008年1月至2009年5月我院30例行PTX的ESRD患者资料,对患者进行多层螺旋CT扫描,再根据Agaston方法计算CAC积分,比较存在CAC者手术前、后CAC积分.比较患者手术前、后甲状旁腺素、血钙、血磷...     

Percutaneous coronary intervention in patients with end-stage renal disease

Patients with end-stage renal disease (ESRD) represent a growing number of patients in the cardiac catheterization laboratories worldwide. This is a consequence of the growing absolute number of ESRD patients in developed countries, better noninvasive diagnostic tools, better catheterization facilities and last-but-not-least better education of referring physicians about the incidence and prognosis of coronary artery disease (CAD) for patients with ESRD. There is growing evidence of the positive impact of coronary revascularization on long-term outcome of these patients. ESRD patients have a high comorbidity and are therefore better candidates for the less invasive approach using percutaneous coronary intervention (PCI) rather than coronary artery bypass surgery (CABG). From the view of the interventional cardiologist, ESRD patients represent one of the most challenging patient cohort concerning technical challenges and potential risk of complication for the patient. Percutaneous coronary intervention (PCI) including debulking techniques and stent implantation is the current standard therapy for patients with symptomatic single-vessel disease (SVD) and the preferred therapy for most patients with focal, polyfocal or even diffuse multi-vessel disease (MVD). Coronary bypass surgery is reserved for a decreasing number of patients with mechanically untreatable coronary lesions and unprotected left main stem stenosis. The problem of restenosis and subsequent target lesion revascularization has been decreased to a minimum by the use of drug-eluting stents (DES), even though prospective randomized trials including ESRD patients are lacking. In case of acute coronary syndromes, the need for immediate coronary angiography and subsequent revascularization by means of PCI should be pointed out.     

Determinants of coronary vascular calcification in patients with chronic kidney disease and end-stage renal disease: a systematic review

BACKGROUND: Vascular calcification (VC) is a recognized process involved in senescence and atherosclerosis. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are conditions associated with metabolic disorders related to soft tissue calcification. METHODS: We performed a systematic review of the literature confined to patients with CKD or ESRD with clinical observations of VC. Case reports of calciphylaxis were excluded. We identified 30 studies over 20 years: 11 prospective cohort, 7 cross-sectional, 11 case-control, and 1 retrospective cohort; n = 2918 subjects, mean age 51 years, 59% men and 41% women. Imaging methods used included: x-ray 43%, computed tomography 30%, ultrasound 17%, and other methods 10%. RESULTS: The most consistent determinants of VC were older age and dialysis vintage. Eight analyses determined a relationship between VC and measures of calcium-phosphate balance while 20 analyses specifically did not find such a relationship. Three studies suggested the degree of calcium loading, treatment with phosphate binders, or treatment with vitamin D analogues were related to VC. When taken into consideration, the lipid profile (primarily low high-density lipoprotein cholesterol, elevated triglycerides, elevated low-density lipoprotein, and elevated total cholesterol) were predictive factors in four analyses. CONCLUSIONS: VC is a common observation in CKD and ESRD and is mainly related to age, length of time on dialysis therapy, and possibly dyslipidemia. The calcium-phosphorus balance and its related treatments are likely not related to this unique form of vascular calcification. Further research into the determinants and potential treatments for vascular calcification is warranted.     

Histopathological assessment of radial artery calcification in patients with end-stage kidney disease

BackgroundA comprehensive understanding of vascular calcification pathology is significant for the development of cardiovascular disease therapy in high-risk populations. This cross-sectional study aimed to evaluate the prevalence and characteristics of radial artery calcification (RAC) and to identify the factors that are associated with RAC in end-stage kidney disease (ESKD).MethodsDetailed medical histories of 180 patients with ESKD were recorded. Fragments of the radial artery obtained during the creation of arteriovenous fistula for hemodialysis access were stained with alizarin red S.ResultsCalcification was localized in the arterial media layer. The prevalence of positive calcification staining in the radial arteries was 21.1% (n = 38). Patients with RAC had a higher glycated hemoglobin level (p < 0.01), higher prevalence of dialysis duration >5 years (p = 0.022), and diabetes mellitus (p < 0.01) than those without RAC. Multiple logistic regression models showed dialysis duration >5 years (odds ratio [OR], 9.864; 95% confidence interval [CI], 2.666–36.502; p < 0.01) and diabetes mellitus (OR, 12.689; 95% CI, 2.796–34.597; p < 0.01) were independent risk factors for RAC in patients with ESKD. Patients with dialysis duration >5 years had a higher prevalence of RAC (p = 0.012) than those with dialysis duration ≤5 years. Patients with diabetes mellitus had a higher prevalence of RAC (p < 0.01) than those without diabetes mellitus. Patients with diabetes mellitus ≥15 years had a higher prevalence of RAC (p = 0.042) than those with diabetes mellitus <15 years. Radial artery calcification level showed a significantly positive correlation with dialysis duration (p < 0.05), diabetes mellitus duration (p < 0.01), HbA1c level (p < 0.01) and Calcium level (p < 0.01).ConclusionsIn patients with ESKD, dialysis duration >5 years and diabetes predict RAC. Thus, the combination of prolonged dialysis and hyperglycemic conditions exerts a synergistic effect on RAC.     

Cardiovascular calcification in patients with end-stage renal disease: a century-old phenomenon

The mortality risk from cardiovascular disease is increased in patients with end-stage renal disease (ESRD). This is due to both traditional and dialysis-specific factors. Recently, a number of the dialysis-specific risk factors have been implicated in the pathogenesis of cardiovascular calcification. These include: hyperphosphatemia, high calcium-phosphate (Ca x P) product, elevated parathyroid hormone levels, duration of dialysis, and treatment with calcium-containing phosphate binders and vitamin D analogs. The recent availability of electron beam computed tomography (EBCT) has triggered increased awareness of the occurrence of cardiovascular calcification in ESRD patients. Given the development of transient hypercalcemia with calcium-containing binders, a link between calcium load from use of calcium-containing phosphate binders and development coronary calcification has been proposed. However, a causal relationship between use of these agents and cardiovascular calcification has not been established. Moreover, this phenomenon had been recognized over a century ago, long before these phosphate binders became available. Although its pathogenesis is likely to be multifactorial, available data strongly implicate elevated serum phosphorus as the primary culprit. Furthermore, the risk of calcification may be aggravated by vitamin D therapy, particularly in patients with severe secondary hyperparathyroidism. Therefore, achieving vigorous control of serum phosphorus, Ca x P product and parathyroid hormone level might decrease cardiovascular calcification and improve survival of patients on maintenance hemodialysis. Since calcium acetate is the most cost-effective phosphate binder available, we recommend that it should remain the first line treatment of hyperphosphatemia in patients with ESRD.     

2型糖尿病患者冠状动脉钙化与骨代谢指标的相关性研究

目的 探讨2型糖尿病患者冠状动脉钙化(coronary arterial calcification,CAC)与骨质疏松症指标的相关性。方法 根据冠脉钙化积分将200例2型糖尿病患者分成冠脉钙化组和对照组,分别记录一般资料,检测血糖、血脂、钙、磷、碱性磷酸酶(alkaline phosphatase,ALP)、N端中段骨钙素(molecular fragment of osteocalcin N terminal,N-MID)、I型胶原羧基端肽交联(β-cross-linked C-telopeptide of type I collagen,β-CTX）等生化指标,同时进行骨密度(bone mineral density,BMD)和冠脉增强CT等检查,探寻BMD、骨代谢指标与CAC等指标是否存在相关性。在此基础上,进一步对冠脉钙化组患者检测指标进行相关性分析。依据冠脉增强CT结果将受试者分为冠脉狭窄组和无冠脉狭窄组,进一步探讨2型糖尿病患者冠脉狭窄与骨质疏松症的关系。结果 冠脉钙化组的年龄、ALP、腰围、体质量指数（body mass index, BMI)、空腹血糖(fasting blood glucose,FBG)高于对照组,差异有统计学意义(P<0.05)。BMD及骨代谢指标组间比较差异无统计学意义(P>0.05)。相关性分析表明,磷、25(OH)D3、β-CTX、甲状旁腺素(parathyroid hormone,PTH)与腰椎、髋部BMD均为负相关(P<0.05);有无冠心病既往史与腰椎BMD为正相关(P<0.05),绝经年限与腰椎BMD为负相关(P<0.05);年龄、绝经年限、收缩压、HDL-C、HOMA-IS与髋部BMD均为负相关(P<0.05)。CAC与各指标的Logistic回归分析表明,冠脉是否钙化与有无冠脉狭窄、有无冠心病既往史、有无颈动脉粥样硬化显著相关(P<0.05)。冠脉狭窄与各指标的Logistic回归分析显示,冠脉是否狭窄与有无冠脉钙化、有无冠心病既往史之间显著相关(P<0.05)。结论 冠脉狭窄与腰椎BMD相关,冠脉钙化与冠脉狭窄显著相关;冠脉狭窄、冠心病既往史、颈动脉粥样硬化是冠脉钙化的危险因素,冠脉钙化是冠心病的致病危险因素。2型糖尿病患者控制血糖、防治骨质疏松症的发生或可降低冠心病的发生风险。     

Prevalence of abdominal artery calcification in dialysis patients with end-stage renal disease: a systematic review and meta-analysis

International Urology and Nephrology - To systematically determine the prevalence of abdominal artery calcification (AAC) in dialysis patients with end-stage renal disease (ESRD) and identify...     

Cardiovascular calcification in end-stage renal disease.

Cardiovascular diseases are common in patients with end-stage renal disease (ESRD) and cardiovascular morbidity and mortality among dialysis patients are substantially higher than in the general population. The reasons for this high incidence are multiple. They include traditional factors such as hypertension, diabetes, dyslipidaemia, sodium overload, and elevated homocysteine levels as well as disturbances of mineral metabolism, specifically abnormalities in phosphorus and calcium homeostasis. This review will describe the specific cardiovascular complications related to calcifications in ESRD, the implications of the abnormalities of mineral metabolism in its pathogenesis and the current imaging techniques available for the detection of cardiovascular calcifications. Excess of calcium load contributes to the development of cardiac calcifications; therefore, alternative strategies to diminish exogenous calcium load should be considered in patients with ESRD.