Quantifying exposure to calcium and phosphate in ESRD; predictive of atherosclerosis on top of arteriosclerosis?

SMART Study Grp

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: Long-term exposure to hypercalcaemia and hyperphosphataemia leads to media calcification and predicts mortality in patients with end-stage renal disease (ESRD). It is debatable whether this exposure is only a risk factor for arteriosclerosis, or also for superimposed atherosclerosis. Calcium-phosphate exposure is difficult to quantify, because it is variable in time and exerts its deleterious effects only after prolonged presence.

Methods: In 90 dialysis patients, calcium and phosphate values from the complete dialysis period were collected. From three-month averages, measures for calcium-phosphate exposure were derived after exclusion of transplant periods. Calcium-phosphate exposure was then related to intima-media thickness (IMT) and to ankle-brachial index (ABI) as markers of early atherosclerosis.

Results: Calcium-phosphate exposure was quantified in three ways using 1670 patient-quarters (i.e. three-months periods) covering 93% of the time on dialysis: averaged calcium-phosphate exposure, percentage of time with above-reference values, and burden of hypercalcaemia/hyperphosphataemia represented by this percentage multiplied by months on dialysis. No association was found with IMT. Patients with increased, not decreased, ABI had higher calcium-phosphate exposure throughout dialysis treatment: hyperphosphataemia burden was 31 (19 to 43) months for patients with ABI between 0.90 and 1.40 and 79 (58 to 100) months for patients with ABI >1.40 or incompressible ankle arteries (p

Conclusion: These findings do not support the hypothesis that calcium-phosphate exposure leads to atherosclerotic changes on top of arteriosclerosis in ESRD, and confirm its role in causing arteriosclerotic damage leading to increased arterial stiffness and incompressible ankle arteries. The used tool for quantifying calcium-phosphate exposure is easy to apply and can properly weigh the complete exposure during ESRD.

Original languageEnglish
Pages (from-to)431-438
Number of pages8
JournalThe Netherlands Journal of Medicine
Volume68
Issue number12
Publication statusPublished - Dec 2010
Externally publishedYes

Keywords

  • Atherosclerosis
  • calcium
  • haemodialysis
  • phosphate
  • quantification
  • CHRONIC KIDNEY-DISEASE
  • ANKLE-BRACHIAL INDEX
  • DISORDERED MINERAL METABOLISM
  • STAGE RENAL-DISEASE
  • HEMODIALYSIS-PATIENTS
  • DIALYSIS PATIENTS
  • MORTALITY RISK
  • VASCULAR CALCIFICATION
  • CARDIOVASCULAR-DISEASE
  • MEDIA CALCIFICATION

Cite this

@article{fd85524763b6482f8a46011a39c57092,
title = "Quantifying exposure to calcium and phosphate in ESRD; predictive of atherosclerosis on top of arteriosclerosis?",
abstract = "Background: Long-term exposure to hypercalcaemia and hyperphosphataemia leads to media calcification and predicts mortality in patients with end-stage renal disease (ESRD). It is debatable whether this exposure is only a risk factor for arteriosclerosis, or also for superimposed atherosclerosis. Calcium-phosphate exposure is difficult to quantify, because it is variable in time and exerts its deleterious effects only after prolonged presence.Methods: In 90 dialysis patients, calcium and phosphate values from the complete dialysis period were collected. From three-month averages, measures for calcium-phosphate exposure were derived after exclusion of transplant periods. Calcium-phosphate exposure was then related to intima-media thickness (IMT) and to ankle-brachial index (ABI) as markers of early atherosclerosis.Results: Calcium-phosphate exposure was quantified in three ways using 1670 patient-quarters (i.e. three-months periods) covering 93{\%} of the time on dialysis: averaged calcium-phosphate exposure, percentage of time with above-reference values, and burden of hypercalcaemia/hyperphosphataemia represented by this percentage multiplied by months on dialysis. No association was found with IMT. Patients with increased, not decreased, ABI had higher calcium-phosphate exposure throughout dialysis treatment: hyperphosphataemia burden was 31 (19 to 43) months for patients with ABI between 0.90 and 1.40 and 79 (58 to 100) months for patients with ABI >1.40 or incompressible ankle arteries (pConclusion: These findings do not support the hypothesis that calcium-phosphate exposure leads to atherosclerotic changes on top of arteriosclerosis in ESRD, and confirm its role in causing arteriosclerotic damage leading to increased arterial stiffness and incompressible ankle arteries. The used tool for quantifying calcium-phosphate exposure is easy to apply and can properly weigh the complete exposure during ESRD.",
keywords = "Atherosclerosis, calcium, haemodialysis, phosphate, quantification, CHRONIC KIDNEY-DISEASE, ANKLE-BRACHIAL INDEX, DISORDERED MINERAL METABOLISM, STAGE RENAL-DISEASE, HEMODIALYSIS-PATIENTS, DIALYSIS PATIENTS, MORTALITY RISK, VASCULAR CALCIFICATION, CARDIOVASCULAR-DISEASE, MEDIA CALCIFICATION",
author = "{SMART Study Grp} and {van Jaarsveld}, {B. C.} and {van der Graaf}, Y. and Vos, {P. F.} and S.S. Soedamah-Muthu",
year = "2010",
month = "12",
language = "English",
volume = "68",
pages = "431--438",
journal = "The Netherlands Journal of Medicine",
issn = "0300-2977",
publisher = "Van Zuiden Communications BV",
number = "12",

}

Quantifying exposure to calcium and phosphate in ESRD; predictive of atherosclerosis on top of arteriosclerosis? / SMART Study Grp.

In: The Netherlands Journal of Medicine, Vol. 68, No. 12, 12.2010, p. 431-438.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Quantifying exposure to calcium and phosphate in ESRD; predictive of atherosclerosis on top of arteriosclerosis?

AU - SMART Study Grp

AU - van Jaarsveld, B. C.

AU - van der Graaf, Y.

AU - Vos, P. F.

AU - Soedamah-Muthu, S.S.

PY - 2010/12

Y1 - 2010/12

N2 - Background: Long-term exposure to hypercalcaemia and hyperphosphataemia leads to media calcification and predicts mortality in patients with end-stage renal disease (ESRD). It is debatable whether this exposure is only a risk factor for arteriosclerosis, or also for superimposed atherosclerosis. Calcium-phosphate exposure is difficult to quantify, because it is variable in time and exerts its deleterious effects only after prolonged presence.Methods: In 90 dialysis patients, calcium and phosphate values from the complete dialysis period were collected. From three-month averages, measures for calcium-phosphate exposure were derived after exclusion of transplant periods. Calcium-phosphate exposure was then related to intima-media thickness (IMT) and to ankle-brachial index (ABI) as markers of early atherosclerosis.Results: Calcium-phosphate exposure was quantified in three ways using 1670 patient-quarters (i.e. three-months periods) covering 93% of the time on dialysis: averaged calcium-phosphate exposure, percentage of time with above-reference values, and burden of hypercalcaemia/hyperphosphataemia represented by this percentage multiplied by months on dialysis. No association was found with IMT. Patients with increased, not decreased, ABI had higher calcium-phosphate exposure throughout dialysis treatment: hyperphosphataemia burden was 31 (19 to 43) months for patients with ABI between 0.90 and 1.40 and 79 (58 to 100) months for patients with ABI >1.40 or incompressible ankle arteries (pConclusion: These findings do not support the hypothesis that calcium-phosphate exposure leads to atherosclerotic changes on top of arteriosclerosis in ESRD, and confirm its role in causing arteriosclerotic damage leading to increased arterial stiffness and incompressible ankle arteries. The used tool for quantifying calcium-phosphate exposure is easy to apply and can properly weigh the complete exposure during ESRD.

AB - Background: Long-term exposure to hypercalcaemia and hyperphosphataemia leads to media calcification and predicts mortality in patients with end-stage renal disease (ESRD). It is debatable whether this exposure is only a risk factor for arteriosclerosis, or also for superimposed atherosclerosis. Calcium-phosphate exposure is difficult to quantify, because it is variable in time and exerts its deleterious effects only after prolonged presence.Methods: In 90 dialysis patients, calcium and phosphate values from the complete dialysis period were collected. From three-month averages, measures for calcium-phosphate exposure were derived after exclusion of transplant periods. Calcium-phosphate exposure was then related to intima-media thickness (IMT) and to ankle-brachial index (ABI) as markers of early atherosclerosis.Results: Calcium-phosphate exposure was quantified in three ways using 1670 patient-quarters (i.e. three-months periods) covering 93% of the time on dialysis: averaged calcium-phosphate exposure, percentage of time with above-reference values, and burden of hypercalcaemia/hyperphosphataemia represented by this percentage multiplied by months on dialysis. No association was found with IMT. Patients with increased, not decreased, ABI had higher calcium-phosphate exposure throughout dialysis treatment: hyperphosphataemia burden was 31 (19 to 43) months for patients with ABI between 0.90 and 1.40 and 79 (58 to 100) months for patients with ABI >1.40 or incompressible ankle arteries (pConclusion: These findings do not support the hypothesis that calcium-phosphate exposure leads to atherosclerotic changes on top of arteriosclerosis in ESRD, and confirm its role in causing arteriosclerotic damage leading to increased arterial stiffness and incompressible ankle arteries. The used tool for quantifying calcium-phosphate exposure is easy to apply and can properly weigh the complete exposure during ESRD.

KW - Atherosclerosis

KW - calcium

KW - haemodialysis

KW - phosphate

KW - quantification

KW - CHRONIC KIDNEY-DISEASE

KW - ANKLE-BRACHIAL INDEX

KW - DISORDERED MINERAL METABOLISM

KW - STAGE RENAL-DISEASE

KW - HEMODIALYSIS-PATIENTS

KW - DIALYSIS PATIENTS

KW - MORTALITY RISK

KW - VASCULAR CALCIFICATION

KW - CARDIOVASCULAR-DISEASE

KW - MEDIA CALCIFICATION

M3 - Article

VL - 68

SP - 431

EP - 438

JO - The Netherlands Journal of Medicine

JF - The Netherlands Journal of Medicine

SN - 0300-2977

IS - 12

ER -